Results in brachial plexus palsy after biceps neuro-muscular neurotization associated with neuro-neural neurotization and teno-muscular transfer.

None of the currently used techniques for elbow flexion recovery in brachial plexus recovery offers enough strength for normal life activities. The association between several methods grants a better result by a summarizing effect compared to each method used separately. The paper reveals the improvement of the functional results in brachial plexus reconstruction by combining the techniques of nerve repair (nerve grafts, nerve transfers or direct muscular neurotization) with palliative muscular transfers. Of the 54 cases of microsurgical reconstruction of brachial plexus palsy, in 20 cases we associated a muscular transposition: 7 latissimus dorsi transfers (5 monopolar and 2 bipolar), 5 pectoralis major and 8 triceps transfers. The direct neuro-muscular neurotization of the biceps-EMG efficient - was associated with a muscular transfer in 8 cases: in 4 of the 7 latissimus dorsi transfers, in 3 cases of triceps transfer and in 2 case of pectoralis major transfer. The association of the 3 methods - direct neuromuscular neurotization, neuro-neuronal neurotization and muscular transfer - has a summarizing effect in the flexion restoration of the elbow flexion, which represents a major problem in the brachial plexus palsy.

The treatment of the sacral pressure sores in patients with spinal lesions.

Sacral pressure sore treatment requires a multidisciplinary approach, the surgical procedures following nutritional and medical status rehabilitation, spasticity control and sepsis treatment. Serial surgical debridement might also precede flap coverage. Gluteal flaps design such as rotation, transposition or V-Y advancement is selected according to the shape and size of the sore. Our experience with 74 patients with 95 flaps includes 38 rotation flaps, 28 V-Y and 8 transposition flaps. Twenty one patients had bilateral gluteal V-Y flaps. Only 2 transposition flaps had marginal necrosis that healed per secundam. Delayed healing occurred in 12 cases due to sepsis, that healed spontaneously in 10 cases and required surgical reintervention for excision and flap reposition in 2. Prolonged bed immobilization, postoperative antibiotic therapy and late suture removal are important factors in surgical success.

[The radial (Chinese) flap in hand surgery]. / Lamboul radial (chinez) în chirurgia mâinii.

The radial (Chinese) flap is an fascio-cutaneous flap raised on the volar aspect of the forearm based on the radial pedicle axis which can be used either pedicled or by microsurgical free transfer. In hand and thumb reconstruction, it is used as an island flap vascularized by a reverse flow from the ulnar artery via the palmar arch, keeping the pivot point at the snuff box level. The possibility to raise a composite flap with vascularized bone or tendons make the chinese flap very useful in hand reconstruction. Of the 35 cases presented, there were 30 pedicled and 5 free flaps from the opposite forearm. The island flaps were reverse flow in 30 cases and with proximal pedicle in 5. In 4 cases the flap contained flexor carpi radialis longus tendon, and in 2 cases a bone graft from the radius. The five free radial flaps transferred from the contralateral side were used as flow-through flap. There were no vascular complications. The advantages and disadvantages of the methods are discussed.

[Hand reconstruction by microsurgical free toe transfer]. / Reconstructia mâinii prin transfer liber microchirurgical de degete de la picior.

Reconstruction of complex hand mutilations with multi-digital or thumb amputations are best treated with microsurgical toe transfers. We present the results of the first 15 cases operated by the first author, of which 12 are thumb reconstructions (6 great toe and 6 second toe transfers) and 3 long fingers reconstructions with combined second and third toe transfers. There were no microsurgical complications. Cortical integration and functional integration was achieved for all transferred toes, with discriminatory sensibility (m2PD between 5 and 13 mm) and active mobility range between 30 and 60 degrees.

[A free microsurgical transfer of a radial (Chinese) flap in reconstructing the lower limb]. / Transferul liber microchirurgical de lambou radial (chinez) în reconstructia membrului pelvin.

UNLABELLED: The microsurgical transplantation of the radial flap to the hind limb has as main advantages to offer a good quality and sensitive skin cover, the possibility to use the flap's radial artery as a vascular bypass and to raise composite flaps with tendon or bone in case of complex reconstruction. MATERIAL AND METHODS: The authors present 9 free radial flap transfers to the foot. Patients' ages ranged from 22 to 50 years. Flap dimensions varied between 7 x 5 cm and 12 x 9 cm. Two flaps contained the flexor carpi radialis tendon to reconstruct the Achilles' tendon and one flap included a bone graft from the radial shaft to resolve a bone defect in the second metatarsal. All flaps were reinnervated by suturing the antebrachial cutaneous nerve of the flap to a cutaneous nerve in the recipient site. RESULTS: There was only one failure in an extensive crush injury. We recommend the radial flap in reconstructing complex defects for it's versatility and for the fact that it can include all types of tissue that may be necessary.