ABSTRACT
Surgical treatment of ulnar nerve syndrome at the elbow gives good results in the majority of cases but there are sometimes incomplete results or recurrences that can lead to iterative procedures. This iterative surgery is responsible for painful neurological sequelae often resistant to pharmacological treatments. In these selected resistant cases, we made the choice of a surgical treatment associating a neurolysis of the ulnar nerve and wrapping with a vascularized flap modified from Lamberty and Cormack. This retrospective study focused on six cases with an average follow-up of 30 months. The results showed an improvement in all patients, especially for the two criteria which best reflect the neuropathic pain: DN4 questionnaire and the visual analog scale of pain. Even if it is a short study, it commits us to continue to apply the principle of covering ulnar neuropathy at the elbow by a vascularized flap.
Subject(s)
Surgical Flaps , Ulnar Neuropathies/surgery , Adult , Elbow , Female , Humans , Male , Middle Aged , Neurosurgical Procedures/methods , Pain/etiology , Pain/surgery , Retrospective Studies , Surveys and Questionnaires , Ulnar Neuropathies/complicationsABSTRACT
PURPOSE OF THE STUDY: To determine the feasibility and interest of an early rehabilitation protocol with no initial immobilisation after proximal row carpectomy. MATERIAL AND METHODS: Thirteen patients were included in this retrospective study. Range of motion (ROM) and wrist strength (grip strength and grasp strength) were evaluated 3 and 6 weeks after surgery on the both wrists (operated and non-operated). Postoperatively, patients had no immobilisation of the wrist, and began a rehabilitation program immediately after surgery in the department of Physical Therapy and Rehabilitation under multidisciplinary team supervision. The same surgical technique was used for all patients by the same surgeon. RESULTS: Six weeks after PRC, there was a 25-51% deficit in passive ROM and 54-64% deficit in active ROM compared to the corresponding non-operated wrist. Six weeks after PRC, mean overall grip strength was nearly 55% and Jamar dynamometer grip strength was 51% of the contralateral side. DISCUSSION: This study shows that immediate immobilisation following PRC is unnecessary, and that early rehabilitation is of the essence. Early rehabilitation could reduce the delay necessary to recover range of motion and strength, and probably the time to return to work. LEVEL OF EVIDENCE: Level 4, prospective cohort study.
Subject(s)
Arthroplasty/methods , Carpal Bones/surgery , Osteoarthritis/surgery , Physical Therapy Modalities , Postoperative Care/methods , Postoperative Complications/rehabilitation , Wrist Injuries/surgery , Adult , Feasibility Studies , Female , Hand Strength/physiology , Humans , Male , Middle Aged , Postoperative Complications/physiopathology , Range of Motion, Articular/physiology , Retrospective Studies , Splints , Wrist Joint/physiopathologyABSTRACT
Because of the septic environment, the reconstruction of extensive losses of substance of the mandible has always raised numerous problems, especially as in a certain number of cases, concomitant radiotherapy represents an additional difficulty. Free flaps offer an important contribution. Up until now, we have essentially used the anterior iliac crest flap vascularised by the deep iliac circumflex pedicle. After 55 flaps of this type, the authors present an analysis of their results and try to analyse the causes for the failures. On the basis of their experience, they consider: that it is preferable to perform the bone and soft tissue repair by means of two different procedures (or at least by means of two different pedicles); that it is preferable, as far as possible, to perform immediate reconstructions rather than deferred reconstructions, especially in the case of malignant tumours.
