A preliminary study on B-mode ultrasonic evaluation of muscle recovery after functional gracilis muscle transplantation / 中华显微外科杂志

Objective To investigate the value of the B-mode ultrasound method for muscle recovery after transplantation.Methods From January,2009 to January,2014,35 patients of functioning free gracilis muscle transplantation for brachial plexus injury were involved.Using B-mode ultrasound to determine the cross-sectional area (CSA) of transplanted gracilismuscle at rest and contraction state.The contraction ratio (CR) and the muscle bulk ratio (MBR) was calculated based on the CSA.Then the CR and MBR were analysised statistically with manual muscle strength and joint range of motion (ROM) to investigate the correlation.Results The followed-up time was 8-24 months,averaged of 22.4 months.The CR of the transplated muscle was (1.23±0.15),which was significantly correlated with muscle strength and joint ROM (P＜0.01,r=0.872,r=0.847,respectively).CR of transplanted muscle with or larger than M4 was greater than that of less than M4 [CR were (1.35±0.10),(1.09±0.06),respectively],and the difference was statistically significant (P＜0.05).The MBR was greater than 1 in 17 cases,and less than 1 in 18 cases.There was no significant correlation between MBR and muscle strength and ROM (P＞0.05).There was no statistically significant difference in muscle strength and ROM between patients with MBR greater than 1 and those with MBR less than 1 (P=0.054,P=0.284,respectively).Conclusion The transplanted muscle recovery can be quantitatively reflected by the CR.CR enlargement of the transplanted gracilis muscle indicated a better recovery of muscle contraction function.MBR is not suitable for evaluating function recovery of transplanted muscles.

An Anatomical Study of Gracilis Muscle and its Vascular Pedicles.

Background: Gracilis muscle being easily accessible and functionally a weak muscle is suitable for muscle graft to replace the damaged muscle in any part of the body. The length of the muscle, vascular pedicles and limited donor site morbidity helps the surgeon to plan accordingly. The muscle receives a number of vascular pedicles ranging from one to five. The source of these pedicles varies. Material and Methods: The study was conducted on 36 formalin fixed lower limbs of both sexes of unknown age from the department of Anatomy, BMCRI, Bangalore. Results and Discussion: In 75% of limbs two vascular pedicles were seen penetrating the muscle at different levels and in 25% accessory pedicles were seen in the lower 2/3rd of the muscle. Conclusion: The findings suggest that the first vascular pedicle to the muscle is always constant in position accompanied by its venae comitans and branch from obturator nerve and is placed at a distance of 10.5cms±2cms from the pubic tubercle.

Flow-through anastomosis using a T-shaped vascular pedicle for gracilis functioning free muscle transplantation in brachial plexus injury

OBJECTIVE: In gracilis functioning free muscle transplantation, the limited caliber of the dominant vascular pedicle increases the complexity of the anastomosis and the risk of vascular compromise. The purpose of this study was to characterize the results of using a T-shaped vascular pedicle for flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury. METHODS: The outcomes of patients with brachial plexus injury who received gracilis functioning free muscle transplantation with either conventional end-to-end anastomosis or flow-through anastomosis from 2005 to 2013 were retrospectively compared. In the flow-through group, the pedicle comprised a segment of the profunda femoris and the nutrient artery of the gracilis. The recipient artery was interposed by the T-shaped pedicle. RESULTS: A total of 46 patients received flow-through anastomosis, and 25 patients received conventional end-to-end anastomosis. The surgical time was similar between the groups. The diameter of the arterial anastomosis in the flow-through group was significantly larger than that in the end-to-end group (3.87 mm vs. 2.06 mm, respectively, p<0.001), and there were significantly fewer cases of vascular compromise in the flow-through group (2 [4.35%] vs. 6 [24%], respectively, p=0.019). All flaps in the flow-through group survived, whereas 2 in the end-to-end group failed. Minimal donor-site morbidity was noted in both groups. CONCLUSIONS: Flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury can decrease the complexity of anastomosis, reduce the risk of flap loss, and allow for more variation in muscle placement. .

Pulmonary Aspergilloma Treated by one Stage Cavernostomy and Myoplasty / 대한흉부외과학회지

A 49-year-old male patient was admitted with chief complaint of hemoptysis. Preoperative chest PA and CT scan revealed air-filled large cavitary lesion at the right upper lobe with typical meniscus sign. Serum anti-fungus antibody for Aspergillus was positive and he was diagnosed as aspergilloma. We planned RULobectomy but it was impossible due to severe pleural adhesion in apex and mediastinal pleura. Therefore, we performed a cavernostomy and serratus anterior muscle flap transposition in one stage. The patient recovered without complication and was followed up for 8 months without recurrence of hemoptysis.

Development of Descending Thoracic Aortomyoplasty for Cardiac Bioassist / 대한흉부외과학회지

BACKGROUND: Thoracic aortomyoplasty is one of the surgical treatment for heart failure and has advantages over artificial heart or intraaortic balloon pumps. It uses autogenous skeletal muscles and solves problems such as energy source. However its use in clinical settings has been limited. This preliminary study was designed to develop surgical technique and to determine the effect of acute descending thoracic aortomyoplsty. MATERIAL AND METHOD: Thirteen adult Mongrel dogs were used. The left latissimus dorsi muscle was wrapped around the descending aorta under general anesthesis. Swan-Ganz and microtipped Millar catheter were used for the hemodynamics and endocaridial viability ratio. Data were collected with myostimulator on and off in normal hearts and the ischemic hearts. RESULT: In normal hearts, the mean aortic diastolic pressure increased from 72+/-15mmHg at baseline to 78+/-13mmHg with stimulator on. Coronary perfusion pressure increased from 61+/-11mmHg to 65+/-9mmHg. Diastolic time increased from 0.288+/-0.003 msec to 0.290+/-0.003msec. Systolic time decreased from 0.164+/-0.002msec to 0.160+/-0.002 msec. Endocardial viability ratio increased from 1.21+/-0.22 to 1.40+/-0.18. In ischemic hearts, mean aortic diastolic pressure incrased from 56+/-21mmHg at baseline to 61+/-15mmHg with stimulator on. Coronary perfusion pressure increased from 48+/-17mmHg to 52+/-15mmHg. Diastolic time increased from 0.290+/-0.003 msec to 0.313+/-0.004msec. Systolic time decreased from 0.180+/-0.002 msec to 0.177+/-0.003 msec. Endovascular viability ratio increased from 0.9+/-0.31 to 1.1+/-0.31. The limited number of cases ruled out the statistic significance. CONCLUSIONS: Descending thoracic aortomyoplasty is a simple operation designed to use patient's own skeletal muscles. It trends to increase diastolic augmentation and coronary perfusion pressure. Modification of surgical technique and stimulator protocol would maximize the effect to assist the heart.

Study on the Short-Term Hemodynamic Effects of Experimental Cardiomyoplasty in Heart Failure Model / 대한흉부외과학회지

BACKGROUND: To evaluate the short-term effect of dynamic cardiomyoplasty on circulatory function and detect the related factors that can affect it, experimental cardiomyoplasties were performed under the state of normal cardiac function and heart failure. MATERIAL AND METHOD: A total of 10 mongrel dogs weighing 20 to 30kg were divided arbitrarily into two groups. Five dogs of group A underwent cardiomyoplasty with latissimus dorsi(LD) muscle mobilization followed by a 2-week vascular delay and 6-week muscle training. Then, hemodynamic studies were conducted. In group B, doxorubicin was given to 5 dogs in an IV dose of 1 mg/kg once a week for 8 weeks to induce chronic heart failure, and simultaneous muscle training was given for preconditioning during this period. Then, cardiomyoplasties were performed and hemodynamic studies were conducted immediately after these cardiomyoplasties in group B. RESULT: In group A, under the state of normal cardiac function, only mean right atrial pressure significantly increased with the pacer-on(p0.05), the larger augmentation effect seen in group B is presumed to be mainly attributed to the viability and contractility of the LD muscle. CONCLUSION: These results indicate that the positive circulatory augmentation effect of cardiomyoplasty is apparent only under the state of heart failure and the preservation of muscle contractility is important to maximize this effect.

Study on Nerve Growth Factor in Promoting Muscular Neurotization of Denervated Vascularized Skeletal Muscle / 实用儿科临床杂志

Objective To investigate the effect of nerve growth factor(NGF)in the process of muscular neurotization of denerva- ted vascularized skeletal muscle.Method By using NGF(0.5 ?g/d) to transplanted skeletal muscle,muscular neurotization was exa- mined with histological,histochemical,electron microscope and immunohistochemical methods at various time.Result NGF was effective in promoting muscular neurotization and diminishing denervated muscle atrophy in grafted denervated skeletal muscle.Conclusion NGF can promote the muscular neurotization and diminish denervated muscle atrophy.

Free Gracilis Muscle Transplantation in Severe Volkmann's Contracture & Brachial Plexus Injury / 대한정형외과학회잡지

Two patients with flexor paralysis of the elbow due to brachial plexus injury and three patients with flexor paralysis of the wrist and fingers due to Volkmann's contracture were treated by transplantation of the gracilis muscle which was detached at both ends and transferred to replace the biceps and long finger flexors, preserving its long and lax neurovascular pedicle. At eleven to fifteen months after operation, the strength and flexion of the elbow were satisfactory and the additional cosmetic effect was obtained. This method should be performed only after a complete study of the patient's general functional needs and the condition of the affected arm, forearm and hand.