Surgical restoration of drop-hand syndrome with tendon transfer in patients injured in the Syrian civil war

Abstract

BackgroundThe radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds, resulting in drop-hand syndrome. The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War.MethodsThis level-II, prospective, comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017. The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension. The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension. The flexor carpi radialis was transferred to the extensor digiti communis for 2nd, 3rd, 4th, and 5th finger extension. All outcomes of thumb abduction and extension, wrist extension, wrist flexion, and finger extension were assessed.ResultsThere was a high level of radial nerve injury in all patients included in the study. The time from injury to treatment ranged from 1.5 months to 9 months. The mechanism of injury most commonly observed was a gunshot wound, which was observed in 8 patients (61.5%), followed by a penetrating cutting tool injury (n = 3; 23.1%) and humerus fracture (n = 2; 15.4%).ConclusionsIn radial nerve injuries, successful results can be achieved with tendon transfer. All patients regained thumb abduction of up to approximately 60°. All the patients were able to bend the wrist, grip, and extend the fingers while in wrist flexion, neutral wrist and wrist extension positions. Although the reason for the radial injury varied, the postoperative outcomes were good for all patients, and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.

A strong reconstruction option for tissue loss on hand and wrist due to firearm injury in the Syrian war

“…[ 26 ] Measures such as anastomosis of subcutaneous vessels to vessels in the recipient area can be beneficial to prevent venous obstruction. [ 27 ] All injuries were in the hand and wrist region developed as a result of FI in all patients, with bone or tendon structures exposed with fractures. [ 14 , 27 ] Tendons and nerve repairs were performed after the fracture reductions of the patients, and then PIF was applied to all patients after preop drawings were made.…”

“…[ 27 ] All injuries were in the hand and wrist region developed as a result of FI in all patients, with bone or tendon structures exposed with fractures. [ 14 , 27 ] Tendons and nerve repairs were performed after the fracture reductions of the patients, and then PIF was applied to all patients after preop drawings were made. We achieved good hemostasis before the skin graft was applied and the adrenaline-produced vasoconstriction is applied to the donor area with gauze soaked in epinephrine, as it can reduce the edema of the donor region and increase skin graft uptake.…”

“…One of the causes of flap failure is the bending of the pedicle; this complication can be prevented by including a contract cage at the inlet of the skin vessels at the entrance of the flap and paying attention during placement of the flap [26] . Measures such as anastomosis of subcutaneous vessels to vessels in the recipient area can be beneficial to prevent venous obstruction [27] . All injuries were in the hand and wrist region developed as a result of FI in all patients, with bone or tendon structures exposed with fractures [14,27] .…”