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[PMID]:29194285
[Au] Autor:Leyngold I; Weller C; Leyngold M; Tabor M
[Ad] Endereço:Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Duke University Hospital, Durham, North Carolina, U.S.A.
[Ti] Título:Endoscopic Corneal Neurotization: Technique and Initial Experience.
[So] Source:Ophthal Plast Reconstr Surg;34(1):82-85, 2018 Jan/Feb.
[Is] ISSN:1537-2677
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The authors describe a minimally invasive surgical technique to re-establish corneal sensibility in a patient with neurotrophic keratopathy with the supraorbital nerve harvested endoscopically. METHODS: Pedicled contralateral supraorbital nerve was harvested endoscopically through small eyelid crease and scalp incisions and transferred to the affected eye. RESULTS: Endoscopic corneal neurotization was successfully performed with restoration of corneal sensibility and corneal epithelial integrity. CONCLUSIONS: The use of an endoscope allows for a minimally invasive approach to successful corneal neurotization with the supraorbital nerve.
[Mh] Termos MeSH primário: Córnea/inervação
Doenças da Córnea/cirurgia
Endoscopia/métodos
Regeneração Nervosa
Transferência de Nervo/métodos
Nervo Oftálmico/cirurgia
Procedimentos Cirúrgicos Oftalmológicos/métodos
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Nervo Oftálmico/fisiopatologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1097/IOP.0000000000001023


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[PMID]:29236823
[Au] Autor:Foroni L; Siqueira MG; Martins RS; Heise CO; Sterman H; Imamura AY
[Ad] Endereço:Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurocirurgia Funcional, Grupo de Cirurgia de Nervos Periféricos. São Paulo SP, Brasil.
[Ti] Título:Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor.
[So] Source:Arq Neuropsiquiatr;75(11):796-800, 2017 Nov.
[Is] ISSN:1678-4227
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Restoration of the sensitivity to sensory stimuli in complete brachial plexus injury is very important. The objective of our study was to evaluate sensory recovery in brachial plexus surgery using the intercostobrachial nerve (ICBN) as the donor. METHODS: Eleven patients underwent sensory reconstruction using the ICBN as a donor to the lateral cord contribution to the median nerve, with a mean follow-up period of 41 months. A protocol evaluation was performed. RESULTS: Four patients perceived the 1-green filament. The 2-blue, 3-purple and 4-red filaments were perceptible in one, two and three patients, respectively. According to Highet's scale, sensation recovered to S3 in two patients, to S2+ in two patients, to S2 in six patients, and S0 in one patient. CONCLUSION: The procedure using the ICBN as a sensory donor restores good intensity of sensation and shows good results in location of perception in patients with complete brachial plexus avulsion.
[Mh] Termos MeSH primário: Plexo Braquial/lesões
Plexo Braquial/cirurgia
Mãos/cirurgia
Nervos Intercostais/transplante
Transferência de Nervo/métodos
[Mh] Termos MeSH secundário: Adulto
Feminino
Seguimentos
Mãos/fisiologia
Seres Humanos
Masculino
Regeneração Nervosa
Estudos Prospectivos
Recuperação de Função Fisiológica
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29262271
[Au] Autor:Zheng MX; Hua XY; Feng JT; Li T; Lu YC; Shen YD; Cao XH; Zhao NQ; Lyu JY; Xu JG; Gu YD; Xu WD
[Ad] Endereço:From the Department of Hand Surgery, Huashan Hospital (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., J.-G.X., Y.-D.G., W.-D.X.), the National Clinical Research Center for Aging and Medicine (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., J.-G.X., Y.-D.G., W.-D.X.), Department of Biostatisti
[Ti] Título:Trial of Contralateral Seventh Cervical Nerve Transfer for Spastic Arm Paralysis.
[So] Source:N Engl J Med;378(1):22-34, 2018 01 04.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Spastic limb paralysis due to injury to a cerebral hemisphere can cause long-term disability. We investigated the effect of grafting the contralateral C7 nerve from the nonparalyzed side to the paralyzed side in patients with spastic arm paralysis due to chronic cerebral injury. METHODS: We randomly assigned 36 patients who had had unilateral arm paralysis for more than 5 years to undergo C7 nerve transfer plus rehabilitation (18 patients) or to undergo rehabilitation alone (18 patients). The primary outcome was the change from baseline to month 12 in the total score on the Fugl-Meyer upper-extremity scale (scores range from 0 to 66, with higher scores indicating better function). Results The mean increase in Fugl-Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft. RESULTS: The mean increase in Fugl-Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft. CONCLUSIONS: In this single-center trial involving patients who had had unilateral arm paralysis due to chronic cerebral injury for more than 5 years, transfer of the C7 nerve from the nonparalyzed side to the side of the arm that was paralyzed was associated with a greater improvement in function and reduction of spasticity than rehabilitation alone over a period of 12 months. Physiological connectivity developed between the ipsilateral cerebral hemisphere and the paralyzed hand. (Funded by the National Natural Science Foundation of China and others; Chinese Clinical Trial Registry number, 13004466 .).
[Mh] Termos MeSH primário: Braço/inervação
Hemiplegia/cirurgia
Espasticidade Muscular/cirurgia
Transferência de Nervo
Nervos Periféricos/transplante
[Mh] Termos MeSH secundário: Potenciais de Ação
Adolescente
Adulto
Encéfalo/diagnóstico por imagem
Lesões Encefálicas Traumáticas/complicações
Paralisia Cerebral/complicações
Avaliação da Deficiência
Hemiplegia/etiologia
Hemiplegia/reabilitação
Seres Humanos
Masculino
Espasticidade Muscular/etiologia
Espasticidade Muscular/reabilitação
Transferência de Nervo/efeitos adversos
Nervos Periféricos/anatomia & histologia
Nervos Periféricos/fisiologia
Acidente Vascular Cerebral/complicações
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1615208


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[PMID]:29280873
[Au] Autor:Hu CH; Chang TN; Lu JC; Laurence VG; Chuang DC
[Ad] Endereço:Taoyuan, Taiwan From the Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and University.
[Ti] Título:Comparison of Surgical Strategies between Proximal Nerve Graft and/or Nerve Transfer and Distal Nerve Transfer Based on Functional Restoration of Elbow Flexion: A Retrospective Review of 147 Patients.
[So] Source:Plast Reconstr Surg;141(1):68e-79e, 2018 01.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical strategy to treat incomplete brachial plexus injury with palsies of the shoulder and elbow by using proximal nerve graft/transfer or distal nerve transfer is still debated. The aim of this study was to compare both strategies with respect to the recovery of elbow flexion. METHODS: One hundred forty-seven patients were enrolled: 76 patients underwent reconstruction using proximal nerve graft/transfer, and 71 patients underwent reconstruction using distal nerve transfer. All patients were evaluated preoperatively and postoperatively to assess the recovery rate and muscle strength of elbow flexion. Shoulder abduction and hand grip power were also recorded to assess any concomitant postoperative changes between the two methods. RESULTS: The best recovery rate for functional elbow flexion (p = 0.006) and the fastest recovery to M3 strength (p < 0.001) were found in the double fascicular transfer group. However, recovery of shoulder abduction with proximal nerve graft/transfer was significantly better than with distal nerve transfer (80.3 percent versus 66.2 percent in shoulder abduction ≥60 degrees; and 56.6 percent versus 38.0 percent in shoulder abduction ≥90 degrees). A significant decrease in grip strength between the operative and nonoperative hands was also found in patients undergoing distal nerve transfer (p = 0.001). CONCLUSIONS: Proximal nerve graft/transfer offers more accurate diagnosis and proper treatment to restore shoulder and elbow function simultaneously. Distal nerve transfer can offer more efficient elbow flexion. Combined, both strategies in primary nerve reconstruction are especially recommended when there is no healthy or not enough donor nerve available. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
[Mh] Termos MeSH primário: Plexo Braquial/lesões
Articulação do Cotovelo/fisiologia
Transferência de Nervo
Traumatismos dos Nervos Periféricos/cirurgia
Amplitude de Movimento Articular
[Mh] Termos MeSH secundário: Adulto
Plexo Braquial/cirurgia
Feminino
Seguimentos
Força da Mão
Seres Humanos
Masculino
Meia-Idade
Recuperação de Função Fisiológica
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003935


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[PMID]:29068931
[Au] Autor:Koshy JC; Agrawal NA; Seruya M
[Ad] Endereço:Houston, Texas; and Los Angeles, Calif. From the Division of Plastic Surgery, Baylor College of Medicine; and the Children's Hospital of Los Angeles.
[Ti] Título:Nerve Transfer versus Interpositional Nerve Graft Reconstruction for Posttraumatic, Isolated Axillary Nerve Injuries: A Systematic Review.
[So] Source:Plast Reconstr Surg;140(5):953-960, 2017 Nov.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The purpose of this study was to compare functional outcomes between nerve grafting and nerve transfer procedures in the setting of isolated, posttraumatic axillary nerve injuries. METHODS: A systematic review was performed using the PubMed, Scopus, and Cochrane databases to identify all cases of isolated, posttraumatic axillary nerve injuries in patients aged 18 years or older. Patients who underwent axillary nerve reconstruction were included and categorized by technique: graft or transfer. Demographics were recorded, including age, time to operation, and presence of concomitant injuries. Functional outcomes were evaluated, including British Medical Research Council strength and range of motion for shoulder abduction. RESULTS: Ten retrospective studies met criteria, for a total of 66 patients (20 nerve grafts and 46 nerve transfers). Median time from injury to operation was equivalent across the nerve graft and nerve transfer groups (8.0 months versus 7.0 months; p = 0.41). Postoperative follow-up was 24.0 months for nerve grafting versus 18.5 months for nerve transfer (p = 0.13). Clinically useful shoulder abduction, defined as British Medical Research Council grade M3 or greater, was obtained in 100 percent of nerve graft patients versus 87 percent of nerve transfer patients (p = 0.09). Grade M4 or better strength was obtained in 85 percent of nerve graft patients and 73.9 percent of nerve transfer patients (p = 0.32). CONCLUSIONS: Significant differences in functional outcomes between nerve graft and transfer procedures for posttraumatic axillary nerve injuries are not apparent at this time. Prospective outcomes studies are needed to better elucidate whether functional differences do exist. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
[Mh] Termos MeSH primário: Axila/inervação
Transferência de Nervo
Traumatismos dos Nervos Periféricos/cirurgia
Nervos Periféricos/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Traumatismos dos Nervos Periféricos/fisiopatologia
Nervos Periféricos/transplante
Recuperação de Função Fisiológica
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003749


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[PMID]:28841616
[Au] Autor:Feng SM; Sun QQ; Cheng J; Wang AG; Li CK
[Ad] Endereço:Xuzhou, Jiangsu, People's Republic of China From the Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College.
[Ti] Título:Superficial Radial Nerve Transection Improves Sensory Outcomes in First Dorsal Metacarpal Artery Flaps.
[So] Source:Plast Reconstr Surg;140(3):558-564, 2017 Sep.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This article reports the operative technique and clinical effect of repairing thumb pulp defects using a modified first dorsal metacarpal artery flap method. In this method, the dorsal branches of the radial and ulnar proper digital nerves of the index finger were preserved but the superficial branches of the radial nerve were transected. METHODS: Data obtained from 121 patients with thumb pulp defects who were admitted to the authors' hospital from June of 2011 to December of 2014 were retrospectively analyzed. Patients were divided into two groups based on whether the superficial branches of the radial nerve were transected. The dorsal branches of the radial and ulnar proper digital nerves of the index finger and the proper digital nerves in the wound were coapted using the end-to-end style. Static two-point discrimination, Semmes-Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, allachesthesia, and patient satisfaction were compared between the two groups. RESULTS: The authors observed significant differences in static two-point discrimination, Semmes-Weinstein monofilament flap score, pain of finger pulp, allachesthesia duration, and patient satisfaction (p < 0.05). The transection group presented slightly better discriminatory sensation in the flap and higher patient satisfaction. In addition, the duration of allachesthesia in the transection group was significantly shorter than that in the preservation group. CONCLUSION: In the repair of thumb pulp defects using a modified first dorsal metacarpal artery flap carrying the dorsal branches of the radial and ulnar proper digital nerves of the index finger, transecting the superficial branches of the radial nerve achieved better clinical outcome compared with preserving them. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
[Mh] Termos MeSH primário: Traumatismos dos Dedos/cirurgia
Transferência de Nervo/métodos
Nervo Radial/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
Transtornos das Sensações/cirurgia
Retalhos Cirúrgicos/irrigação sanguínea
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Transtornos das Sensações/etiologia
Polegar/cirurgia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003582


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[PMID]:28684285
[Au] Autor:van Veen MM; Dijkstra PU; Werker PMN
[Ad] Endereço:University of Groningen, University Medical Centre Groningen, Department of Plastic Surgery, Groningen, The Netherlands. Electronic address: m.m.van.veen@umcg.nl.
[Ti] Título:A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal-facial nerve jump graft in facial palsy treatment.
[So] Source:J Plast Reconstr Aesthet Surg;70(11):1666-1674, 2017 Nov.
[Is] ISSN:1878-0539
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Nerve reconstructions are the preferred technique for short-standing facial paralysis, most commonly using the contralateral facial nerve or ipsilateral hypoglossal nerve. The hypoglossal nerve provides a strong motor signal, whereas the signal of a cross-face nerve graft is weaker but spontaneous. Spontaneity in facial expression is believed to be important for psychological wellbeing. Therefore, a combination of the two procedures incorporates the best of both: a strong motor signal and a spontaneous smile. This study aimed to objectify this expected benefit. Of the 20 patients who received a hypoglossal-facial nerve anastomosis from 1995 to 2015 in our institutions, 12 patients were included in this study, 5 with and 7 without a cross-face nerve graft. The outcomes were compared using photographs, disease-specific quality of life (Facial Clinimetric Evaluation (FaCE) scale), a self-reported synkinesis scale (Synkinesis Assessment Questionnaire) and the presence of a spontaneous smile. Significant differences were found in preoperative excursion of the affected side of the mouth and the change in excursion. Median Total FaCE scores were considerably larger (18.3 points) for patients who underwent the combined procedure. A spontaneous smile was observed both with (n = 2) and without (n = 1) a cross-face nerve graft. The addition of a cross-face nerve graft to a hypoglossal-facial nerve anastomosis resulted in a positive trend in disease-specific quality of life. This benefit could also be present with the combination of a cross-face nerve graft with another nerve transfer such as a masseteric-facial nerve anastomosis.
[Mh] Termos MeSH primário: Nervo Facial/cirurgia
Paralisia Facial/cirurgia
Nervo Hipoglosso/transplante
Músculo Esquelético/transplante
Transferência de Nervo/métodos
Qualidade de Vida
Ritidoplastia/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Criança
Expressão Facial
Paralisia Facial/fisiopatologia
Feminino
Seguimentos
Seres Humanos
Masculino
Microcirurgia/métodos
Meia-Idade
Estudos Retrospectivos
Sorriso
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE


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[PMID]:28617736
[Au] Autor:Chen G; Wang W; Wang W; Ding W; Yang X
[Ad] Endereço:Shanghai, People's Republic of China From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine.
[Ti] Título:Symmetry Restoration at Rest after Masseter-to-Facial Nerve Transfer: Is It as Efficient as Smile Reanimation?
[So] Source:Plast Reconstr Surg;140(4):793-801, 2017 Oct.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Masseter-to-facial nerve transfer is a highly efficient technique for reanimating paralyzed muscle and has been reported to restore facial symmetry at rest. However, no systematic studies have been performed, and the effects of preoperative droop of the oral commissure on postoperative symmetry at rest have rarely been reported. METHODS: The authors retrospectively analyzed 35 patients with masseteric-to-facial nerve anastomosis and assessed the quality and quantity of the dynamic recovery and the oral commissure symmetry at rest. The dynamic and static effects were then compared. RESULTS: All of the patients' Terzis scores were increased postoperatively, and over half of the patients presented restored symmetric smiles (Terzis scores of 4 or 5). The postoperative symmetry scale of the oral commissure at rest improved in 18 of 35 patients. Both the mean postoperative altitude difference of oral commissure excursion and the postoperative altitude difference of bilateral oral commissure position were decreased compared with preoperative values. The preoperative symmetry had a significant effect on the postoperative altitude difference of the bilateral oral commissure position. The effects of the dynamic and static symmetry improvements were transformed to a comparable factor α. The dynamic α was significantly greater than the static α. CONCLUSIONS: Masseter-to-facial nerve transfer is a reliable technique for smile reanimation. However, it has only a limited effect on the improvement of symmetry at rest. Assessing the preoperative symmetry of the oral commissure at rest can be used to predict postoperative outcomes, and patients with severe droop of the oral commissure (symmetry scale grade III or IV) should receive static suspension.
[Mh] Termos MeSH primário: Nervo Facial/transplante
Paralisia Facial/cirurgia
Músculo Masseter/inervação
Transferência de Nervo/métodos
Recuperação de Função Fisiológica
Ritidoplastia/métodos
Sorriso/fisiologia
[Mh] Termos MeSH secundário: Adulto
Expressão Facial
Paralisia Facial/fisiopatologia
Feminino
Seguimentos
Seres Humanos
Masculino
Microcirurgia/métodos
Meia-Idade
Descanso
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003698


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[PMID]:28609352
[Au] Autor:O'Grady KM; Power HA; Olson JL; Morhart MJ; Harrop AR; Watt MJ; Chan KM
[Ad] Endereço:Edmonton and Calgary, Alberta, Canada From the Department of Occupational Therapy, Glenrose Rehabilitation Hospital; the Division of Plastic Surgery, the Department of Pediatrics, Faculty of Medicine, and the Division of Physical Medicine and Rehabilitation, University of Alberta; and the Division of Plastic Surgery, University of Calgary.
[Ti] Título:Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury.
[So] Source:Plast Reconstr Surg;140(4):747-756, 2017 Oct.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Upper trunk obstetric brachial plexus injury can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and health care costs between nerve grafting and distal nerve transfers in children with upper trunk obstetric brachial plexus injury. METHODS: In this prospective cohort study, children who underwent triple nerve transfers were followed with the Active Movement Scale for 2 years. Their outcomes were compared to those of children who underwent nerve graft reconstruction. To assess health care use, a cost analysis was also performed. RESULTS: Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years after surgery (p < 0.05). The operative time and length of hospital stay were significantly lower (p < 0.05), and the overall cost was approximately 50 percent less in the nerve transfer group. CONCLUSION: Triple nerve transfer for upper trunk obstetric brachial plexus injury is a feasible option, with better functional shoulder external rotation and forearm supination, faster recovery, and lower cost compared with traditional nerve graft reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
[Mh] Termos MeSH primário: Traumatismos do Nascimento/cirurgia
Neuropatias do Plexo Braquial/cirurgia
Plexo Braquial/lesões
Transferência de Nervo/métodos
Procedimentos Cirúrgicos Reconstrutivos/métodos
Nervo Sural/transplante
Tronco/inervação
[Mh] Termos MeSH secundário: Plexo Braquial/cirurgia
Feminino
Seguimentos
Seres Humanos
Lactente
Masculino
Estudos Prospectivos
Recuperação de Função Fisiológica/fisiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003668


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[PMID]:28574948
[Au] Autor:Maldonado AA; Bishop AT; Spinner RJ; Shin AY
[Ad] Endereço:Rochester, Minn.; and Frankfurt, Germany From the Department of Neurologic Surgery and the Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic; and the Department of Plastic, Hand and Reconstructive Surgery, BG Unfallklinik Frankfurt.
[Ti] Título:Five Operations That Give the Best Results after Brachial Plexus Injury.
[So] Source:Plast Reconstr Surg;140(3):545-556, 2017 Sep.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Treatment of brachial plexus injuries has improved slowly over the past 45 years. Changes in strategy, techniques, microsurgical equipment, and technology have expanded the surgical options for reconstructing these life-altering, highly complex injuries. The surgical techniques available include neurolysis, nerve repair, nerve grafting, nerve transfers, tendon transfer, muscle transfer, and other soft- and bony-tissue procedures. In this article, the authors have selected five surgical procedures (i.e., Oberlin procedure, Leechavengvongs procedure, free functional muscle transfer, radial nerve tendon transfers, and C5-C6 nerve grafting in obstetric birth palsy) that have consistently yielded good results in patients who require surgical reconstruction.
[Mh] Termos MeSH primário: Neuropatias do Plexo Braquial/cirurgia
Plexo Braquial/lesões
Plexo Braquial/cirurgia
Procedimentos Neurocirúrgicos/métodos
[Mh] Termos MeSH secundário: Seres Humanos
Músculo Esquelético/transplante
Transferência de Nervo/métodos
Procedimentos Cirúrgicos Reconstrutivos/métodos
Transferência Tendinosa/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170603
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003620



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