Reconstrução de úmero e reanimação do cotovelo com retalho osteomiocutâneo da escápula: relato de caso / Reconstruction of the humerus and rehabilitation of the elbow using an osteomyocutaneous scapular flap: a case report

Introdução: No presente trabalho, relatamos um caso de reconstrução do terço proximal do úmero direito e reanimação do cotovelo de um paciente masculino, de 20 anos, vítima de acidente automobilístico, com necrose óssea de 5 cm no terço proximal do úmero e avulsão do bíceps braquial. Métodos: Utilizamos o retalho ósseo da escápula, associado ao retalho miocutâneo do grande dorsal, tendo como pedículo os vasos subescapulares. Resultados: O paciente teve excelente evolução no pós-operatório, apresentando-se, no pós-operatório de 2 meses, com consolidação óssea e iniciando a flexão do cotovelo. Conclusões: Perante a utilização do retalho descrito, concluímos que esta modalidade de retalho se insere no arsenal dos retalhos ósseos de maior segurança nas reconstruções ósseas em geral.

Introduction: We report a case of reconstruction of the proximal third of the right humerus and rehabilitation of the elbow in a 20-year-old male patient who was injured in an automobile accident and developed bone necrosis of 5 cm at the proximal third of the humerus and avulsion of the brachial biceps. Methods: A scapular bone flap was used, together with a latissimus dorsi myocutaneous flap, using subscapular vessels for the pedicle. Results: The patient had excellent postoperative course, presenting in the 2-month postoperative period with bone consolidation and initiation of elbow flexion. Conclusions: This flap modality is a safe and useful option for bone reconstruction.

Neurorrhaphy techniques: comparative stereological and experimental axonal study / Técnicas de neurorrafia: estudio experimental estereológico axonal comparativo

There is a great variety of injuries that affect peripheral nerves derived from acquired or congenital degenerative diseases affecting the central nervous system that cause loss of sensorimotor functions. The objective of this work was to perform an end-to-side or side-to-side experimental axonal stereological study in order to compare volume density of axons, endouneuro and myelin sheath (and muscle mass) in peroneal and tibial nerves, with anastomosis contact from 0.25 cm to 0.50 cm. After approval of the Ethics Committe, 20 male Wistar rats were divided into four groups of five rats each (G1= end-to-side neurorrhaphy; G2= side-to-side neurorrhaphy of 0.25 cm; G3= side-to-side neurorrhaphy of 0 cm and G4= Control of normality). After 180 days, fragments of peroneal and tibial nerves were collected for histological and stereological study. In comparative stereological experimental study between neurorraphies, the volume density of axons, myelin sheath of tibial and fibular nerves, as well as the post-surgical muscle mass, remains the same in end-to-side and side-to-side neurorraphies, regardless of contact area of anastomosis. It can be inferred, as surgical repair options, both end-to-side neurorrhaphy to recover and prevents atrophy of the endplate as side-to-side neurorraphy that is independent of the distance between the nerve stumps.

Gran variedad de lesiones atingen a los nervios periféricos, derivadas de enfermedades adquiridas o degenerativas congénitas que afectan la parte central del sistema nervioso y que ocasionan pérdida de funciones sensoriomotoras. El objetivo de ese trabajo fue realizar un estudio experimental estereológico axonal post neurorrafias termino-lateral o latero-lateral para comparar densidad de volumen de axones, endoneuro y vaina de mielina (así como masa muscular) en nervios fibular y tibial, con unión de contacto entre 0,25 cm y 0,50 cm. Tras la aprobación del comité de ética, fueran utilizados 20 ratones machos de la raza Wistar divididos en cuatro grupos de 5 ratones cada uno (G1= Neurorrafia término lateral; G2= Neurorrafia latero lateral de 0,25 cm; G3= Neurorrafia latero lateral de 0,50 cm y G4= Control). Posteriormente, fragmentos de los nervios tibiales y fibulares fueron procesados para estudios histológicos y estereológicos. En el estudio experimental estereológico comparativo entre neurorrafias termino-lateral y latero-lateral, la densidad de volumen de axones, endoneuro y vaina de mielina de nervios tibial y fibular y también la masa muscular post quirúrgica se mantuvo equitativa, independientemente del área de unión de contacto. Podemos inferir como opciones de reparación quirúrgica, que el tratamiento de la neurorrafia termino-lateral y latero-lateral previnen la atrofia de placa motora, independiente de la distancia entre los muñones nerviosos.

End-to-side loop neurorrhaphy: axonal comparative stereological study / Neurorrafia de blucle termino-lateral: estudio axonal estereológico comparativo

Accidents or diseases can affect the peripheral part of the nervous system, which raises clinical and surgical therapies, among others. In this context, the technique of end-to-side neurorrhaphy is a treatment option, yet its modification loop needs some additional efficacy studies. The purpose of this study was to compare, among rats, stereological results (axons volume density) after end-to-side neurorrhaphy and after end-to-side loop neurorrhaphy. Thirty Wistar rats were used, divided into six groups (five animals per group), consisting of two control groups (for the fibular and tibial nerves), two study groups for the fibular nerve (one with an end-to-side neurorrhaphy, and the other with an end-to-side loop neurorrhaphy) and two study groups for the tibial nerve (with an end-to-side neurorrhaphy and the other one with an end-to-side loop neurorrhaphy). After 180 days, all groups were sacrificed for axonal stereological analysis (volume density) in distal nerve stumps. There was significant maintenance of neuronal-axonal density in the distal stumps to neurorrhaphy (p<0.005) compared with the normal stumps. The end-to-side loop neurorrhaphy is a therapeutic option as suture technique after complete nerve section, in order to restore most of the axonal functional integrity.

Accidentes o enfermedades pueden afectar a la parte periférica del sistema nervioso, lo que plantea terapias clínicas y quirúrgicas, entre otras. En este contexto, la técnica de neurorrafia término-lateral es una opción terapéutica, sin embargo, su modificación en bucle necesita algunos estudios adicionales de eficacia. El objetivo de este estudio fue comparar, en ratas, resultados estereológicos (densidad de volumen axonal) después de la neurorrafia término-lateral y de la neurorrafia en bucle término-lateral. Fueron utilizadas 30 ratas Wistar, divididas en seis grupos (cinco animales por grupo), siendo dos grupos control (para los nervios fibular y tibial), dos grupos estudio del nervio fibular (uno con neurorrafia término-lateral y otro con neurorrafia en bucle termino-lateral) y dos grupos estudio del nervio tibial (uno con neurorrafia término-lateral y otro con neurorrafia en bucle término-lateral). Después de 180 días, todos los grupos fueron eutanasiados y se realizó el análisis estereológico axonal (densidad de volumen) en muñones nerviosos distales. Hubo un mantenimiento significativo de la densidad neuronal-axonal en los muñones distales a la neurorrafia (p<0,005) en comparación con los muñones normales. La neurorrafia en bucle término-lateral es una opción terapéutica como técnica de sutura después de la sección completa del nervio, con el fin de restaurar la mayoría de la integridad funcional axonal.