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Management of Total Paralysis of the Brachial Plexus by the Double Free-muscle Transfer TechniqueFrom the Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi City, Japan Correspondence: Kazuteru Doi, MD, PhD, Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Shimoga 862-3, Ogori, Yamaguchi City, Yamaguchi-ken 754-0002, Japan. Tel.: +81 83 972 0333; fax: +81 83 973 8610. E-mail: doimicro{at}saikyo.or.jp. The double free-muscle transfer technique achieved a dramatic revolution in the treatment of total paralysis of the brachial plexus by providing universal prehensile function, although several requirements such as successful free-muscle transfers, stability of the proximal joints and prolonged postoperative rehabilitation are necessary for the success of this procedure. To obtain the best outcome of double free-muscle transfer, it is imperative to understand the key factors, viz. selection of the donor muscle, meticulous microsurgical technique, importance of proximal joint stability, selection of the kind of grip and postoperative rehabilitation. Double free-muscle transfer is not a simple microsurgical muscle transfer for finger movement, but a universal reconstructive procedure for total paralysis of the upper limb.
Key Words: brachial plexus • free-muscle transfer • prehension • nerve transfer • shoulder function
Journal of Hand Surgery (European Volume), Vol. 33, No. 3,
240-251 (2008) |
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