Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization

Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain

Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization

Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-yearold man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain

Clinical Applications of End-to-Side Neurorrhaphy: An Update

End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management

Porcine Model for Internal Mammary Vessels Harvesting

Recipient vessels selection is crucial for successful microsurgical breast reconstruction. The internal mammary vessels (IMVs) have gained great popularity, and they are often selected as first choice recipient vessels. The IMVs can be exposed for microvascular anastomosis through a rib-removing (trans-costal) or a rib-sparing (intercostal) approach.1\u20133 Because the vessels are located between the rib cage and the parietal pleura, adequate training is needed to avoid and eventually manage bleedings and pleural perforation. This training is better performed in a nonhuman model. Our aim was to investigate the pig as a surgical model for IMVs harvesting to be used in training

Update on nerve repair by biological tubulization

Many surgical techniques are available for bridging peripheral nerve defects. Autologous nerve grafts are the current gold standard for most clinical conditions. In selected cases, alternative types of conduits can be used. Although most efforts are today directed towards the development of artificial synthetic nerve guides, the use of non-nervous autologous tissue-based conduits (biological tubulization) can still be considered a valuable alternative to nerve autografts. In this paper we will overview the advancements in biological tubulization of nerve defects, with either mono-component or multiple-component autotransplants, with a special focus on the use of a vein segment filled with skeletal muscle fibers, a technique that has been widely investigated in our laboratory and that has already been successfully introduced in the clinical practice

Lower Limb Core Scale: A New Application to Evaluate and Compare the Outcomes of Bone and Soft-Tissue Tumours Resection and Reconstruction

Several methods are used to evaluate the functional outcome of tumour resections and reconstructions in the lower limb. However, one of their most common limitations is that they are specifically developed to evaluate only oncological patients. We introduced the Lower Limb Core Scale (LLCS) to overcome this limitation. The aim of this study was to evaluate the functional and subjective results in the lower limb and to evaluate the use of the LLCS. We conducted a retrospective cohort study using various tools to investigate the outcomes. The results of the LLCS were correlated with the results of other functional tests. A total of 44 patients were included in the study. None of the demographic variables correlated with the functional or health-related quality of life (QoL) scores except for gender, whereby male patients had an increased functional score. The correlation between LLCS and other scores was positive (r2=0.77). The satisfactory QoL scores, and functional outcomes scores indicated the LLCS to be a reliable option for general and specific evaluation of lower limb reconstructions. We suggest using the LLCS for comparisons of oncological reconstructions with lower limb reconstructions in different disciplines

Lembi perforanti sul modello animale vivente. CAPITOLO 03.

La tecnica operatoria che permette di alle- stire i lembi perforanti richiede delicatezza e precisione. Questo tipo di dissezione deve essere ap- preso ed af nato prima di arrivare alla esperienza clinica sull\u2019 umano ed il metodo migliore per otte- nere questa esperienza \ue8 l\u2019esercizio assiduo. In generale i modelli per l\u2019esercizio chirurgico di tecniche ni come la microchirurgia sono quel- li sintetici e i piccoli animali (ratti, conigli). Ove l\u2019esercizio da apprendere non sia di pura micro- chirurgia (con le anastomosi microvascolari) ma di preparazione di lembi perforanti, siano essi pe- duncolati o microchirurgici, i metodi migliori per fare esperienza sembrerebbero essere la pratica su cadavere e la pratica su modello vivente ani- male.1 L\u2019esercizio su cadavere \ue8 molto utile soprattutto per l\u2019apprendimento della reale dimensione e di- stribuzione dei vasi perforanti e in generale delle strutture anatomiche nell\u2019essere umano. Gli svan- taggi della dissezione su cadavere sono quello della impossibilit\ue0 di simulare le reali dif colt\ue0 che si incontrano in clinica. In particolare la mancanza di una circolazione sanguigna attiva, fa s\uec che il campo operatorio sia sempre pulito e che possa- no essere trascurati alcuni aspetti fondamentali come la precisa e dettagliata emostasi di tutti i vasi minori che non sia necessario preservare. \uc8 questa la ragione per cui riteniamo molto utile la pratica chirurgica dei lembi perforanti sul model- lo animale vivente che ha l\u2019enorme vantaggio di riprodurre fedelmente tutte le possibili dif colt\ue0 chirurgiche incontrate in clinica. I tessuti inoltre hanno la consistenza e la malleabilit\ue0 che han- no i tessuti umani. Alla ne della dissezione del lembo, \ue8 possibile veri care la vitalit\ue0 del lembo, sia per la perfusione arteriosa che per il drenag- gio venoso e quindi in conclusione la correttezza dell\u2019esercizio chirurgico