Early rehabilitation of victims of traumatic ulnar injury using tendon transfer.

BACKGROUND: Poor awareness among the patients and lack of resources for proper management of nerve injuries leads to delayed presentation of most traumatic ulnar nerve injuries. When this injury is present in the proximal forearm it leads to poor outcomes as Ulnar nerve repair with grafts takes a prolonged time to restore function. Addition of a tendon transfer to this procedure can allow patients to return to work earlier. The purpose of this study is to examine whether the addition of a tendon transfer to nerve repair surgery will lead to improved hand function and rehabilitation earlier than nerve grafting alone in cases of delayed presentation of Ulnar nerve injuries. METHODS: A retrospective analysis of patients with traumatic ulnar nerve injury with duration of injury more than 1 month and location > 5 cm proximal to the flexor retinaculum who required a sural nerve graft for repair was done using Sollerman Hand Function test (SHFT). The SHFT scores were recorded for these patients at end of one year following repair with nerve grafting and status of employment at end of 6 and 12 month of surgery recorded as well. Another group of patients with traumatic ulnar injury of the same profile were given Fritchi tendon transfer along with sural nerve graft and followed up prospectively for a period of one year and SHFT score with status of employment recorded. RESULTS: On comparison of employment status at 6 months we found that among the tendon transfer group 15/20 (75%) were employed while only 4/16 (20%) in the control group were able to return to work. Chi square test shows a p value of 0.002 (significant at p < 0.05). On evaluation at end of 1 year after surgery we found 18/20 (90%) had returned to work in the tendon transfer group while 8/16 (50%) had found employment again in the control group. Chi square test shows a p value 0.007 (significant at p < 0.05) CONCLUSION: These outcomes suggest that addition of a tendon transfer with nerve grafting promotes early rehabilitation, especially in patients employed in manual labor.

Assessment of perfusion of free flaps used in head and neck reconstruction using pulsatility index.

OBJECTIVE: To detect venous or arterial obstruction in the pedicle of a free flap we can monitor resistance in the flap bed which is reflected in Pulsatility Index (PI) Therefore if we detect change in the values of the PI in these flaps then we can detect complications in flap due to vascular insufficiency early. MATERIALS AND METHODS: Seven patients of Free Fibular Flap Reconstruction and ten patients of Free Radial Forearm Flap reconstruction were evaluated over a period of 18 months. In the pre op we recorded PI of Radial and Peroneal artery using colour doppler study. In the Post Operative Period 2 readings of PI at the anastomotic site were taken on Day 1 and Day 7. RESULTS: Both Free Radial Forearm and Free Fibula flaps which were healthy (n = 15) showed a significant decrease in PI values on first Post Op day as compared to Pre Op. Also there was a significant fall in PI on Post Op Day 7 as compared to post op Day 1 (P < 0.05) in these flaps. The flaps developing complications (n = 2) had significantly higher Day 1 Post op PI readings as compared to healthy flaps (P < 0.05). CONCLUSION: PI is an objective index which can indicate changes in perfusion of free flaps used in Head and Neck reconstruction based on which we can predict if a flap is susceptible to circulatory compromise.