An experimental study of postoperative monitoring for innervated free muscle graft by the compound muscle action potential in rabbits.

This experiment establishes the principles of using the compound muscle action potential (CMAP) as a possible postoperative monitor for free muscle grafts. Twenty rabbits were divided into two groups of ten each to investigate the effects of ischemia on CMAP of the muscles. Rectus femoris model was used and contralateral muscle was used as control. In all muscles total normothermic ischemia of 1.5 hours to mimic the time needed for transfer and inset of the flap was followed by occlusion of the artery in one group and vein in another group after 3 hours. During this ischemia of 1 hour, the CMAP amplitudes decreased and the latencies were prolonged. Latency prolongation was detected within 10 minutes of total, arterial, or venous ischemia. During the revascularization, both amplitude and latency improved, but not to the original values at the start. The results show that CMAP monitoring can provide easily detectable, objective indication of vascular compromise to a muscle graft within as early as 10 minutes of total, arterial, and venous ischemia. Changes in latency are more constant and predictable compared with amplitude changes. This method can provide continuous monitoring and can be used in buried muscle grafts.

Mycobacterium marinum as a cause of chronic granulomatous tenosynovitis in the hand.

OBJECTIVE: Mycobacterium marinum is an uncommon cause of chronic granulomatous flexor tenosynovitis and leads to significant morbidity in the hand. This paper aims to review our treatment of this infection and its clinical outcomes. METHODS: We treated five cases of M. marinum flexor tenosynovitis from 2001 to 2006, which were confirmed after 6 weeks of mycobacterial culture. RESULTS: All the patients were healthy immuno-competent hosts. There was a history of injury by a marine animal in each patient. Presentation was delayed at an average of 32.0 days after the injury. Excisional debridement was performed at an average of 63.4 days after the injury. The average number of debridements performed was 3.4. One patient had to undergo ray amputation to control the infection. The average duration of oral antibiotics was 15.4 weeks. Post-operatively, there were reductions in total active motion in all patients. CONCLUSION: A high index of suspicion, based on the history and intra-operative findings, is necessary when managing these patients. This infection runs a protracted course that requires multiple debridements and is associated with poor functional outcome.

Extending the reach of the heterodigital arterialized flap by vein division and repair.

The heterodigital arterialized flap is ideal for nonsensory reconstruction of sizable soft-tissue defects in the proximal fingers, web spaces, and the hand. The inclusion of a dorsal vein augments the venous drainage of this digital island flap and avoids the problem of postoperative venous congestion, which is a common problem in digital island flaps. However, the presence of a dorsal vein pedicle inhibits flap mobility somewhat, and the reach of the flap is mainly limited to adjacent fingers. In situations that demand a transfer from a nonadjacent donor finger or when the reach from the adjacent donor finger is inadequate, the dorsal vein pedicle can be temporarily divided and then anastomosed microsurgically after flap transfer is performed. This enables the reach of the flap to be extended up to two fingers from the donor finger. The authors performed this "partially free" heterodigital arterialized flap in 11 consecutive patients between 1991 and 2001. The average size of the defects was 4.4 x 2.3 cm. All of the flaps survived completely, without any evidence of postoperative flap congestion. Healing of all of the flaps was primary and did not result in any scarring. All of the donor fingers had "normal" two-point discrimination of 3 to 5 mm. All of the donor fingers retained excellent or good total active motion, as graded by the criteria of Strickland and Glogovac.

Basic science behind functioning free muscle transplantation.

Free muscle transfer is now a feasible procedure in several fields of reconstructive surgery. In this article, basic science behind clinical free muscle transfer, including essential aspects like donor muscle selection (type of blood supply, architecture of fibers, fiber length, and muscle volume), donor nerve selection, placement and routing of muscle, tension of muscle at suturing, postoperative monitoring of muscle circulation, postoperative reinnervation, and rehabilitation are discussed in detail.