A Decade of Imaging Patients with Traumatic Brachial Plexopathy: What have We Learned?

Aim In this paper, the authors share their experience of imaging patients with traumatic brachial plexopathy by magnetic resonance neurography (MRN) spanning over a period of nearly 10 years. Setting and Design This was a single-institution, prospective, observational study conducted between August 2012 and March 2022. Materials and Methods Children and adults presenting to the plastic surgery outpatient department with features of traumatic brachial plexopathy were included in the study. The MRN study was performed in a 1.5T scanner (Magnetom Essenza, Siemens, Erlangen, Germany). The area scanned extended from C3 level to T3 level. Statistical Analysis Descriptive statistics (percentages, mean, median, and mode). Results A total of 134 patients ( n = 134) were included in the study. The age of our patients ranged from 6 months to 65 years. The mean age was 24.95 ± 12.10 years, with a median of 23 years. All patients had unilateral injury, and the right side was more commonly involved. Road traffic accident was the most common mode of injury, and blunt crush-avulsion was the most common mechanism of injury. Involvement of shoulder, elbow, and hand together (panplexopathy) was the most common clinical presentation. Conclusion This study of patients with traumatic brachial plexopathy imaged by MRN, spanning nearly a decade, has led to several interesting observations. The majority of these injuries occur in young men from urban areas who usually present with panplexopathy. The most common mode of injury is road traffic accident, and blunt crush-avulsion is the most common mechanism of injury.

Clinical utility of i-gel® and BlockBuster™ supraglottic devices for airway management in postburn injury contracture neck patients under general anesthesia: A randomized controlled trial.

Background: Post burn injury contracture (PBC) neck patients pose a unique challenge for the anesthesiologists. The use of supraglottic device (SGDs) for managing such patients is being increasingly used. We compared i-gel® and LMA BlockBuster™ in PBC adult patients under general anesthesia (GA). Methods: The study included 63 subjects with mild/moderate PBC neck of either sex with American Society of Anesthesiologists Physical Status I and II under GA. Patients with intraoral pathology, mouth opening <2.5 cm, and severe contracture were excluded. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups. The primary objective of the study was the time for successful insertion. First attempt success rate, oropharyngeal leak pressures (OLP), and complications were also assessed. Results: Mean insertion time was significantly less in Group I as compared to Group B (17.35 ± 1.43 vs. 21.32 ± 1.10 s; P < 0.001), OLP in Group B was significantly higher as compared to Group I (34.03 ± 1.33 vs. 25.23 ± 3.04 cm of H2O; P < 0.001). Group I was found to be statistically easier to insert as compared to Group B (P = 0.011) with reduced requirement of airway maneuvering to insert the device (P = 0.017). Groups were similar in terms of complications. Conclusion: SGDs are attractive option for airway management in mild/moderate degree of PBC neck. i-gel® having shorter insertion time with easier insertion can be favorable at times of emergency while use of LMA BlockBuster™ can be preferred to reduce the risk of aspiration owing to higher OLP.

MR neurography in Parsonage-Turner syndrome.

BACKGROUND AND AIMS: Parsonage Turner Syndrome is a well known clinical entity. Several excellent articles have succinctly described Magnetic Resonance Imaging (MRI) findings in PTS. However, these articles have inferred neural involvement in PTS based on the patterns of denervation of muscles in the shoulder region. The aim of this study is to directly visualize the distribution and extent of abnormality in MR Neurography (MRN) of the brachial plexus in known cases of brachial plexus neuritis or Parsonage-Turner Syndrome (PTS). METHODS: 15 patients who were diagnosed with PTS based on clinical and electrophysiological findings participated in the study. MRN of the brachial plexus was done in a 1.5T system using a combination of T1W (T1-weighted), T2W (T2-weighted) fat-saturated, STIR (Short Tau Inversion Recovery), 3D STIR SPACE (Sampling Perfection with Application Optimized Contrasts) and 3D T2W SPACE sequences. Findings were recorded and assessed. RESULTS: The age range of our patients was 7-65 years (mean 37.87 years). Most of the patients had unilateral symptoms. All patients had weakness in shoulder abduction. Other common associated complaints included pain in the shoulder/neck/arm and preceding fever. MRN revealed the percentage of involvement of roots, trunks, cords and terminal branches was 53.3%, 46.7%, 40% and 13.3% respectively. Evidence of muscle denervation in the form of edema, fatty infiltration and atrophy was noted in 8 (53.3%) patients. CONCLUSION: Most of the patients in this study had unilateral involvement on MRN. The roots were the commonest site of involvement followed by the trunks, cords and terminal branches. C5 was the most commonly involved root.

Acquired Localized Cutis Laxa: A Case Report and the Role of Plastic Surgery.

Cutis laxa is an uncommon connective tissue disorder affecting the elastin fibers leading to lax and pendulous skin and in generalized form can present with systemic involvement. Congenital cutis laxa is common in comparison to acquired cutis laxa and has varied inheritance patterns. Treatment is chiefly observation in congenital cutis laxa, and there is a paucity of literature on surgical management in acquired cutis laxa. We report a rare case of acquired localized cutis laxa with a review of literature on the role of plastic surgery in this condition.

'Sausage finger' with 'Rice bodies'.

Although both pulmonary and extrapulmonary tuberculosis (TB) are commonly encountered in developing countries, tenosynovitis is an uncommon presentation of musculoskeletal TB. TB mimics a lot of other conditions and causes diagnostic dilemma in day-to-day practice. We present the case of a 30-year-old male who presented with the complaints of swelling of right index finger which was initially suspected to be giant cell tumour of the flexor tendon sheath but on histological examination turned out to be tuberculous tenosynovitis.

MR neurography in traumatic, non-obstetric paediatric brachial plexopathy.

OBJECTIVES: Many studies have elaborated on the role of magnetic resonance neurography (MRN) in evaluating traumatic brachial plexopathies. Most of these deal with MR findings in adult traumatic plexopathies or children with obstetric brachial plexus palsy (OBPP). Hence, the authors felt the need for this particular study, which focuses on MRN findings in children with non-obstetric traumatic brachial plexus palsy, to find out the distribution and severity of injuries in these patients. METHODS: This was a single-institution, prospective study conducted between April 2015 and June 2016. All children presenting to the hospital with features of brachial plexopathy and a history of non-obstetric trauma were included in the study. RESULTS: At MRN, we looked for signs of injury at three levels: roots, trunks and cords. Signs of injury were found at the level of the roots in 22 patients (88%), at the level of the trunks in 20 patients (80%) and at the level of the cords in 22 patients (88%). CONCLUSIONS: This study, conducted on children suffering from non-obstetric, traumatic brachial plexopathy returned some interesting conclusions including that when the paediatric plexus is injured, the injury is severe and multi-level, with a very high incidence of root injuries. KEY POINTS: • Brachial plexus injury in paediatric age group is a devastating injury. • The most common cause of this is trauma sustained during birth. • Other causes include road traffic accidents and blunt injury. • MR neurography has revolutionised the diagnosis of brachial plexopathy.

Magnetic resonance neurography of the brachial plexus.

Magnetic Resonance Imaging (MRI) is being increasingly recognised all over the world as the imaging modality of choice for brachial plexus and peripheral nerve lesions. Recent refinements in MRI protocols have helped in imaging nerve tissue with greater clarity thereby helping in the identification, localisation and classification of nerve lesions with greater confidence than was possible till now. This article on Magnetic Resonance Neurography (MRN) is based on the authors' experience of imaging the brachial plexus and peripheral nerves using these protocols over the last several years.

Future and training of craniofacial surgery in India.

Craniofacial surgery, in the strictest sense, is the surgery of structures above and behind the maxilla. Craniofacial surgery is not new to India and has been around for more than 4 decades now since the 1970s. Keeping in mind the promotion of the specialty in India, an Indian Craniofacial Foundation was launched in the year 2012 at the Annual Meeting of the Association of Plastic Surgeons of India. To develop a craniofacial center in India, the primary requirement is a source of funding. Several craniofacial centers, which are already running successfully in India, have amply demonstrated that this can be done in several ways. We would like to discuss here the 2 models of craniofacial service delivery and training that the authors have seen and experienced firsthand.

Cholecysto-hydatid cyst fistula.

A 27-year-old woman developed recurrent hydatid of liver. CT scan showed unilocular cysts in segments IV and VII. Intraoperatively, there was a fistulous communication between the gall bladder and the cyst in segment IV. Partial pericystectomy along with cholecystectomy was done for the segment IV cyst; percutaneous aspiration, instillation and re-aspiration using hypertonic saline was done for the cyst in segment VII. This was followed by albendazole treatment.