Journal of Brachial Plexus and Peripheral Nerve Injury最新文献

Many surgical techniques are available for bridging peripheral nerve defects. Autologous nerve grafts are the current gold standard for most clinical conditions. In selected cases, alternative types of conduits can be used. Although most efforts are today directed towards the development of artificial synthetic nerve guides, the use of non-nervous autologous tissue-based conduits (biological tubulization) can still be considered a valuable alternative to nerve autografts. In this paper we will overview the advancements in biological tubulization of nerve defects, with either mono-component or multiple-component autotransplants, with a special focus on the use of a vein segment filled with skeletal muscle fibers, a technique that has been widely investigated in our laboratory and that has already been successfully introduced in the clinical practice.

In this study an unusual combination of arterial, venous and neural variations discovered during dissection of cervical, axillary and brachial area of a cadaver is described. Variations are thoroughly described and literature is briefly reviewed. Lateral cord of brachial plexus was not formed; Eight Cervical root divided into anterior and posterior division before uniting with First Thoracic root and Upper Trunk was unusually short. Axillary artery gave origin to a superficial brachial artery and then continued as deep brachial artery. Multiple variations in typical axillary artery branches were present including existence of inferior pectoral artery. Cephalic vein was absent. A variety of interventions, from relative simple as central venous catheter placement to most complicated as brachial plexus injury repair demand thorough knowledge of area's regional anatomy. Familiarity with anatomic variations allows more precise and careful interventions. Research on these variations is valuable for anatomists and embryologists but also for clinicians because it may provide useful information for non - typical cases but also helps in raising a high level of suspicion.

Background: Post-traumatic lumbosacral plexus injuries seem to be rare events, spontaneously recovering in high percentage: as surgery is often challenging and results in poor outcome, many Authors have advocated conservative treatment only. Nevertheless surgery should not be ruled out: in invalidating injuries, it can restore basic function in the lower extremities.Therefore, it might be necessary to establish guidelines for the management and the indication to surgery in such cases.This study aims to identify indicators predicting spontaneous recovery or the need for surgery.

Method: The clinical and radiological data of 72 patients with a post-traumatic lumbosacral plexus injury were reviewed. A follow up equal or superior to 3 years is available in 42 cases.

Results: Lumbosacral plexus injuries mostly occurred during road accidents. The incidence of associated lesions was relevant: bone injuries were found in 85% of patients, internal lesions in 30% and vascular injuries in 8%.Lumbosacral trunk and sacral plexus palsies were the most frequent injury patterns.Root avulsions were revealed in 23% of cases and only in sacral plexus and complete lumbosacral plexus injuries: L5 and S1 were the roots more prone to avulsions.About 70% of cases recovered spontaneously, mostly in 18 months. Spontaneous recovery was the rule in lumbar plexus and lumbosacral trunk injuries (where root avulsions never occurred) or in sacral and complete lumbosacral plexus palsies due to compression injuries.The causative mechanism correlated with the injury pattern, the associated bone injury being often predictive of the severity of the nerve injury.Lumbosacral plexus injuries occurred in car crashes were generally associated with fractures causing compression on the nerves, thus resulting in injuries often amenable of spontaneous recovery.Motorcycle accidents implied high kinetic energy traumas where traction played an important role, as the high percentage of sacroiliac joint separations demonstrated (found in more than 50% of cases and always associated to root avulsions).Loss of sphincteral control and excruciating leg pain were also invariably associated with avulsions.

Conclusions: Clinical and radiological data can help to predict the occurrence of spontaneous recovery or the need for surgery in post-traumatic lumbosacral plexus injuries.

Brachial plexus schwannomas are rare tumors. They are benign nerve sheath tumors and only about 5% of Schwannoma arise from the brachial plexus. They pose a great challenge to surgeons due to their rare occurrence and complex anatomical location. We present two cases who presented with a supraclavicular swelling, that were proven to be schwannoma on histopathology.

We report the case of a 34-year-old man with a total brachial plexus injury that was treated by free functional muscle transplantation to restore simultaneously elbow flexion and finger extension. The muscle had a very large muscle belly (12 cm width), which was considered anatomically to be a fusion of the gracilis and the adductor longus muscles. Although the muscle possessed two major vascular pedicles with almost equal diameters, only the proximal vascular pedicle was anastomosed to the recipient vessels during the transplantation surgery, resulting in partial necrosis of the muscle. Several authors have reported on the successful simultaneous transplantation of the gracilis and adductor longus muscles, because they are supplied generally by a single common vascular pedicle. However, the present study suggests that when a surgeon encounters an aberrant femoral adductor with a very large muscle belly that can be considered to be a fusion of these muscles, the surgeon should assess intraoperatively the vascularity of the muscle using Doppler sonography, indocyanine green fluorescence injection, or other techniques.

Background: Many disorders of the musculoskeletal system are caused by modified net joint forces resulting from individual coping movement strategies of patients suffering from neuromuscular diseases. Purpose of this work is to introduce a personalized biomechanical model which allows the calculation of individual net joint forces via inverse dynamics based on anthropometry and kinematics of the upper extremity measured by 3D optoelectronical motion analysis.

Methods: The determined resulting net joint forces in the anatomical axis of movement may be used to explain the reason for possible malfunction of the musculoskeletal system, especially joint malformation. For example the resulting net joint forces in the humerothoracic joint from simulations are compared to a sample of children presenting obstetric brachial plexus palsy showing an internal shoulder rotation position and a sample of healthy children.

Results: The results presented from the simulation show that an increased internal shoulder rotation position leads to increased net joint forces in the humerothoracic joint. A similar behavior is presented for the subjects suffering from brachial plexus palsy with an internal shoulder rotation position.

Conclusions: The increased net joint forces are a possible reason for joint malformation in the humerothoracic joint caused by coping movements resulting from neuromuscular dysfunction as stated in literature.