Current status of magnetic resonance neurography in evaluating patients with brachial plexopathy.

Magnetic resonance neurography (MRN) is recognized as the imaging modality of choice in the evaluation of patients with brachial plexopathy. It adds vital information to the results of the clinical evaluation and electrodiagnostic tests and facilitates patient management. Its indications include both trauma and non-traumatic forms of plexopathy such as inflammatory, neoplastic and compressive. This article will familiarize readers with the routine MRN protocol in clinical practice and discuss the utility of the different sequences. The timing of the scan is important, especially with reference to trauma and this has been discussed. Both the advantages and limitations of MRN have been elaborated upon.

MR neurography in traumatic brachial plexopathy.

OBJECTIVES: Imaging of the brachial plexus has come a long way and has progressed from plain radiography to CT and CT myelography to MRI. Evolution of MR imaging sequences has enabled good visualization of the small components of the plexus. The purpose of our study was to correlate the results of MR neurography (MRN) in patients with traumatic brachial plexopathy with their operative findings. We wanted to determine the usefulness of MRN and how it influenced surgical planning and outcome. METHODS: Twenty patients with features of traumatic brachial plexopathy who were referred to the MRI section of the Department of Radiology between September 2012 and January 2014 and subsequently underwent exploration were included in the study. MR neurography and operative findings were recorded at three levels of the brachial plexus-roots, trunks and cords. RESULTS: Findings at the level of roots and trunks were noted in 14 patients each and at the level of the cords in 16 patients. 10 patients had involvement at all levels. Axillary nerve involvement as a solitary finding was noted in two patients. These patients were subsequently operated and their studies were assigned a score based on the feedback from the operating surgeons. The MRN study was scored as three (good), two (average) or one (poor) depending on whether the MR findings correlated with operative findings at all three levels, any two levels or at any one level, respectively. CONCLUSIONS: MR neurography is an extremely useful modality to image the traumatized brachial plexus. It influences both surgical planning and outcome/prognosis.

Functional reconstruction of complex tendo Achilles defect by free latissimus dorsi muscle flap.

Managing the complex tendo Achilles defect involves reconstructing the Achilles tendon as well as providing soft tissue cover to the heel area. The advent of microsurgery has revolutionised the reconstruction of this difficult defect providing a number of options to the reconstructive surgeon. We present a case of complex tendo Achilles defect reconstructed by the latissimus dorsi free flap.

The transversely split gracilis twin free flaps.

The gracilis muscle is a Class II muscle that is often used in free tissue transfer. The muscle has multiple secondary pedicles, of which the first one is the most consistent in terms of position and calibre. Each pedicle can support a segment of the muscle thus yielding multiple small flaps from a single, long muscle. Although it has often been split longitudinally along the fascicles of its nerve for functional transfer, it has rarely been split transversely to yield multiple muscle flaps that can be used to cover multiple wounds in one patient without subjecting him/her to the morbidity of multiple donor areas.

Sincipital encephaloceles.

An encephalocele is a protrusion of the cranial contents beyond the normal confines of the skull through a defect in the skull and the facial bones. Encephaloceles are classified according to their contents, site of exit through the skull/facial bones, and the path traversed through the face. Sincipital encephaloceles are the most common variety seen in the Asian population. Sincipital encephaloceles have been classified by Suwanwela and Suwanwela (1972) into frontoethmoidal, interfrontal, and those associated with craniofacial clefts. Correction of encephaloceles can be done in 1 stage or multiple stages and consists of excision of the encephalocele sac, repair of the bony defect, correction of hypertelorism/telecanthus, and correction of associated deformities such as trigonocephaly and the "long nose."