Brachial Plexus Injuries with Ulnar Musculocutaneous Transfer: 78 Cases Study Focused on Possible Postoperative Complications

Objective To analyze 78 cases of brachial plexus injury submitted to the Oberlin technique between 2003 and 2012. The potential complications of this technique were analyzed, especially motor damage or hypoesthesia of the hand. Method Medical records from patients with brachial plexus injuries at the levels of the C5-C6 and C5-C6-C7 vertebrae were retrospectively analyzed. Cases submitted to the Oberlin procedure with or without concomitant brachial plexus procedures between 2003 and 2012 were evaluated. The minimum follow-up period was of 1 year. In addition to the clinical examination, electromyography and magnetic resonance imaging (MRI) of the brachial plexus were used to diagnose and locate the nerve damage. Results A total of 78 surgical patients met the inclusion criteria. Postoperative neurological changes, mostly transient, were observed in 18 patients. Hypoesthesia in the ulnar side of the handwas observed in seven cases; neuropathic pain in five cases; allodynia in four cases, and hand motor loss in two cases. Conclusion Based on the results of the present case series, we conclude that there are few sequelae in the donor nerve territory compared with the benefit of the Oberlin technique on the recovery of elbow flexion after brachial plexus injuries.

Expression of MuRF1 and MAFbx in donor and recipient muscles after musculocutaneous nerve transection and partial pectoralis major muscle transfer for reconstruction of elbow flexion in rats / Expresión de MuRF1 y MAFbx en músculos donantes y receptores después de transección del nervio musculocutáneo y transferencia parcial del músculo pectoral mayor para la reconstrucción de flexión de codo en ratas

The expression of MuRF1 and MAFbx in a denervated muscle has previously been studied. However, the expression of MuRF1 and MAFbx in the recipient and donor muscles after muscle transfer for reconstruction of joint function has not been sufficiently investigated. Forty-two adult Sprague-Dawley rats were divided into 7 groups: normal, 1 w post-, 2 w post-, and 4 w post-musculocutaneous nerve transection; and 1 w post-, 2 w post-, and 4 w post-reconstruction of elbow flexion. Muscle wet weights were assessed, and MuRF1 and MAFbx mRNA expressions were detected by polymerase chain reaction. The length of the oblique part of the pectoralis major of an SD rat is sufficient for suture to the insertion of the biceps brachii tendon. The muscle wet weight and the wet weight retention rate of the biceps brachii continued to decline after musculocutaneous nerve transection and a gradual increase was noted after the oblique part of the pectoralis major was transferred for reconstruction of elbow flexion. The oblique part of the pectoralis major showed a decrease of only 2­6%. The upregulated expression of MuRF1 and MAFbx in the biceps brachii reached a peak 2 w after denervation and 1 w after elbow flexion reconstruction, with an increase of 15% and 4%, respectively. This was followed by downregulation; however, the expression had not normalized at postoperative 4 w. The increased expression of MuRF1 (17%) and MAFbx (1%) in the oblique part of the pectoralis major at postoperative 1 w had decreased to below normal levels at postoperative 4 w. The transfer of the oblique part of the pectoralis major for elbow flexion reconstruction after musculocutaneous nerve transection can downregulate the expression of MuRF1 and MAFbx in the recipient muscle and causes only transient damage to the donor muscle in rats.

La expresión de MuRF1 y MAFbx en un músculo denervado ha sido estudiada previamente. Sin embargo, la expresión de MuRF1 y MAFbx en los músculos receptores y donantes después de la transferencia del músculo para la reconstrucción de la función articular no se ha investigado lo suficiente. Cuarenta y dos ratas adultas Sprague-Dawley fueron divididas en 7 grupos: normales, 1 semana post-, 2 semanas post- y 4 semanas post-transección del nervio musculocutáneo; y 1 semana post-, 2 semanas post-, y 4 semanas post-reconstrucción de la flexión del codo. Se evaluó el peso de los músculos húmedos, y las expresiones de MuRF1 y MAFbx mRNA fueron detectadas a través de reacción en cadena de la polimerasa. La longitud de la parte oblicua del músculo pectoral mayor de una rata Sprague-Dawley es suficiente para realizar la sutura en la inserción del tendón de músculo bíceps braquial. El peso húmedo del músculo bíceps braquial y su tasa de retención siguieron disminuyendo después de la sección del nervio musculocutáneo y un aumento gradual se observó después de la transferencia de la parte oblicua del músculo pectoral mayor para la reconstrucción de la flexión del codo. La parte oblicua del músculo pectoral mayor mostró una disminución de sólo 2-6%. La expresión regulada por incremento de MuRF1 y MAFbx en el bíceps braquial alcanzó un peak 2 semanas después de la denervación y 1 semana después de la reconstrucción de la flexión del codo, con un incremento del 15% y el 4%, respectivamente. Esto fue seguido por un regulación en baja. Sin embargo, la expresión no se normalizó en el postoperatorio de las 4 semanas. El aumento de la expresión de MuRF1 (17%) y MAFbx (1%) en la parte oblicua del músculo pectoral fue mayor en el postoperatorio de 1 semana, mientras que se encontró por debajo de los niveles normales en el postoperatorio de 4 semanas. La transferencia de la parte oblicua del músculo pectoral mayor para la reconstrucción de la flexión del codo después de la sección del nervio musculocutáneo puede regular a la baja la expresión de MuRF1 y MAFbx en el músculo receptor y provocar solo un daño transitorio en el músculo donado en ratas.

Padronização das técnicas operatórias de autonomização no retalho musculocutâneo transverso do músculo reto do abdome monopediculado: estudo experimental em ratas / Standardization of autonomic operative techniques in rectus abdominis transverse miocutaneous flap: experimental study in rats

Objetivo: Padronizar as técnicas operatórias de autonomização aplicadas previamente ao descolamento e elevação do músculo reto do abdome (Retramcur) com sutura no próprio leito e estabelecer qual delas é a mais efetiva na redução da necrose do retalho. Métodos: Oitenta ratas Wistar, pesando entre 250gramas a 300gramas foram distribuídas aleatoriamente em oito grupos de dez ratas (n=10). O grupo A foi considerado o grupo controle, no qual as ratas foram submetidas ao descolamento e elevação do Retramcur, com sutura no próprio leito. Os animais dos grupos B, C, D, E, F, G e H foram submetidos a diferentes técnicas operatórias de autonomização previamente ao descolamento e elevação do Retramcur, com sutura no próprio leito. As medidas das áreas de necrose do Retramcur foram realizadas no quinto dia pós-operatório, utilizando-se um molde retirado de uma folha de transparência, caneta de ponta fina Pilot Ò e folha milimetrada padronizada, papéis técnicos Foroni Ò , na qual foi realizada a medida da extensão da área de necrose de cada retalho em porcentagem. Resultados: Para análise estatística dos resultados foi aplicado o teste para diferenças significativas mínimas ou LSD (Least Significante Difference). O grupo A (controle) apresentou, em média, porcentual de área de necrose estatisticamente superior em relação aos demais grupos. A técnica operatória utilizada nos animais do grupo C apresentou, em média, porcentual de área de necrose estatisticamente inferior a dos grupos H, B, F e G e semelhante a dos grupos D e E. Conclusão: Os resultados encontrados permitem concluir que a técnica operatória de autonomização mais efetiva na redução da área de necrose do Retramcur é a que seccionou ambos os músculos retos do abdome e cauterizou ambos os vasos epigástricos superiores profundos, utilizada nos animais do grupo C.

Brachial plexus trauma: management by inter costal nerve transfer of the musculocutaneous nerve

Brachial plexus injuries are common in patients with road traffic accidents and missile injuries. Management is difficult and differs according to the level of the lesion. Intercostal nerve transfer is a well-established and effective technique for irreparable brachial plexus injuries. Thirteen cases of brachial plexus injuries were treated in the Department of Neuro Surgery, Bolan Medical College Quetta by intercostal to musculocutaneous nerve transfer, without nerve graft to obtain elbow flexion; between 1994 and 1998. The results were evaluated clinically using scale developed by Wright and used by Daniels, William and Worthingham. The overall success rate with motor functions of grade 4 or more was obtained in 65 percent of the patients. Factors contributing towards good results were early operation [less than 5 months after trauma], use of 3 intercostal nerves, mixed nerve to mixed nerve anastomosis, nerve repair without graft or tension and shoulder stability