Nerve Injury Management - Part 1-Dr. Shin - Nerve Injury Management

Dr. Shin - Nerve Injury Management - Part 1

Pdf Summary

The document discusses the use of free functioning muscle transfers (FFMT) in adult traumatic brachial plexus injuries. The author, Alexander Y. Shin, MD, provides an overview of this treatment option and its indications. Brachial plexus injuries, which result in limited nerve sources and devastating consequences, commonly occur in adults.<br /><br />Nerve grafting and nerve transfer are traditional treatment options for brachial plexus injuries. However, the use of FFMT offers a microvascular transfer of a muscle with the goal of restoring function. The most common muscles used for FFMT are the gracilis, latissimus, and rectus femoris, and indications for this procedure include acute and chronic brachial plexus injuries, traumatic loss of forearm muscles, tumor reconstruction, and facial reanimation.<br /><br />The document describes the surgical procedure for a free functioning gracilis transfer, including the harvest of the gracilis muscle, identification of vessels and nerves, detachment of tendons, and reattachment of the muscle in the upper extremity. The team approach is emphasized to minimize ischemic time and ensure successful revascularization and nerve transfer.<br /><br />Post-operative care involves immobilization, reinnervation, and strengthening, with an average time of 6-9 months for clinical improvements. The document also mentions the Doi procedure, a double gracilis transfer that offers hope for improved function in complete avulsion injuries.<br /><br />The results of FFMT, specifically the Doi procedure, have shown satisfactory outcomes in terms of elbow flexion and prehension. The future role of FFMT is discussed, including its potential for driving myoelectric devices and improving grasp and overall outcomes. Additionally, advances in amputation and myoelectric prosthetics are mentioned as alternative options if other surgical techniques fail.<br /><br />In conclusion, FFMT is a viable treatment option for adult traumatic brachial plexus injuries, offering hope for improved function. The combination of neurotization and FFMT may lead to a paradigm shift in treatment approaches, ultimately improving grasp and outcomes for patients with these debilitating injuries. The document acknowledges the Mayo Clinic Brachial Plexus Team and quotes Sterling Bunnell, stating, "To someone who has nothing a little is a lot."

Keywords

free functioning muscle transfers

FFMT

adult traumatic brachial plexus injuries

nerve grafting

nerve transfer

gracilis muscle

latissimus muscle

rectus femoris muscle

surgical procedure

Doi procedure