Scapular osseous free flap in head and neck reconstruction: An assessment of the postoperative function of the donor site.

BACKGROUND: The scapular osseous free flap (SOFF) has become an important reconstructive option for complex head and neck defects. Postoperative donor site function is, however, an important consideration. The objective of this study was to prospectively investigate SOFF donor site morbidity and to relate the findings to hand dominance and neck dissection. METHODS: Objective assessment included bilateral measurement of shoulder, elbow, and hand range of motion (ROM), hand strength, and distal nerve function in consecutive patients with head and neck cancer SOFF reconstruction at a tertiary referral center in Sweden between 2016 and 2019. The subjective function was assessed by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Sixteen of 20 consecutive patients were evaluated (median follow-up 10 months [range 3-17]). Significant side differences in shoulder range of motion (ROM) (flexion, abduction, external and internal rotation) were observed for patients where the SOFF had been harvested from the same side as their dominant hand (n = 9; Ps ≤ 0.04). For patients where the SOFF was harvested from the non-dominant hand side, no significant shoulder ROM side differences were observed (n = 7; Ps ≥ 0.08). There were significant side differences in shoulder ROM for patients who underwent neck dissections (n = 12; Ps ≤ 0.03), not for the other four patients. Patients reported low but varying DASH scores (median 2.5, range 0-57). CONCLUSION: Postoperative donor site morbidity seems to be quite acceptable after SOFF surgery. The results indicate possible benefits of choosing the non-dominant hand side for the SOFF and that a neck dissection affects postoperative shoulder outcome. Further studies are however needed.

Relative Factors of Functional Recovery after Upper Limb Replantation / 中国康复理论与实践

Objective To analyze the relative factors of functional recovery after upper limbs replantation. Methods From September, 2009 to March, 2014, 24 consecutive patients after upper limb replantation for amputation were retrospectively analyzed. The Disability of Arm Shoulder and Hand (DASH) was used to assess the functional recovery of the upper limbs at the last follow-up. The non-conditional Logistic regression was used to analyze the correlation of gender, age, time from injury to surgery, amputated level, amputated method, isch-emia hours, dominant hand or not, rehabilitation treatment, rehabilitation duration, and the DASH scores. Results The DASH score was>28.50 in 15 patients, while ≤28.50 in 9 patients. The Logistic regression analysis demonstrated that amputated method and rehabilitation treatment correlated with the functional recovery of upper limbs (χ2>7.360, P0.05). Conclusion The amputated method and rehabilitation treatment after operation are the factors related to the func-tional recovery after upper limb replantation.

Application of Valpar 4 System in Rehabilitation of Hand Injury / 中国康复理论与实践

@# Objective To observe the effect of Valpar 4 system on hand injury. Methods 40 patients with hand injury were randomly divided into control group and observation group with 20 patients in each group. Routine treatment was applied in both groups while Valpar 4 system was added in the observation group. Then total active motion (TAM) of finger joints, Disability of Arm Shoulder and Hand (DASH), and Upper Extremity Function Test (UEFT) were carried out before, 2 weeks and 4 weeks after treatment. Results The TAM improved significantly in the control group 2 weeks after treatment (P<0.001). The TAM, DASH and UEFT improved significantly in the observation group (P<0.001), and the DASH and UEFT were better in the observation group than in the control group (P<0.001). 4 weeks after treatment, the TAM and UEFT improved significantly (P<0.001) in the control group, the TAM, DASH, UEFT significantly improved in the observation group (P<0.001), and were better in the observation group than in the control group (P<0.05). Conclusion Valpar 4 system can effectively improve the TAM of fingers, function of hands and upper limb, especially in terms of activities of daily living of upper limbs.