Transfer of the Extensor Digiti Minimi and Extensor Carpi Ulnaris Branches of the Posterior Interosseous Nerve to Restore Intrinsic Hand Function: Case Report and Anatomic Study

Tung, Thomas H.; Barbour, John R.; Gontre, Gil; Daliwal, Gurpreet; Mackinnon, Susan E.

doi:10.1016/j.jhsa.2012.10.010

Cited by 24 publications

(8 citation statements)

References 14 publications

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“…One of the drawbacks of the flap is clearly the sacrifice of a part of the entire extensor muscle (EDM or ECU) but the functional deficit seems to be negligible, resulting in a slight reduction in extension strength and loss of abduction of the 5th finger (Iyer, ; Tung, Barbour, Gontre, Daliwal, & Mackinnon, ; except in rare cases of absent EDC‐V tendon slips in which the sacrifice of the EDM muscle must be avoided).…”

Section: Discussionmentioning

confidence: 99%

The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand

et al. 2019

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Introduction There is growing evidence of the superior ability of muscular tissue to clear bacterial bone infection. Unfortunately, in the hand, there are almost no small local muscular flaps, and muscular transfers to the hand are mainly microsurgical free transfers. In this report, we present the results of the use of a chimeric posterior interosseous flap including part(s) of the forearm muscles to treat osteomyelitis and soft tissue defect of hand from a series of patients. Patients and Methods Four male patients with an average age of 32 years (range 20–46 years), were affected by acute osteomyelitis in hand. Previous fracture fixation with percutaneous K‐wires was the cause of bone infection in three case. In one case, the osteomyelitis was a consequence of an open fracture. The bones affected were four metacarpals and one proximal phalanx, all with a minimal cortical defect (from the K‐wire) obscuring a larger medullary infection, which required extensive bone and overlying soft tissue debridement, leaving a soft tissue defect to be reconstructed of size ranging from 2 x 4 cm to 5 x 7 cm. The soft tissue defects were due to concomitant superficial infection and consequent debridement. All patients were treated with bone debridement and a chimeric posterior interosseous flap, which included part of the extensor digiti minimi and/or extensor carpi ulnaris to fill the intramedullary canal of the bones. No fixation of bone was necessary. Results The skin paddle of the flaps ranged from 2 x 5 cm to 5 x 6 cm, replicating the defect area, plus a teardrop tail of skin circa 1.5 cm wide and as long as the pedicle of the flap. The muscular components of the flaps used to fill the intramedullary canals ranged from 1 x 1 x 1.5 cm to 1.5 x 1.5 x 4 cm. All flaps survived and osteomyelitis resolved in all cases without major complications. At the final follow‐up at 16 months (range 12–26 months), assessment of the hands using TAM, Power Grip and Key Pinch Strength measurements and, where appropriate, Kapandji scores, demonstrated satisfactory hand function. Conclusion The chimeric posterior interosseous flap including part of the muscles of the forearm may be a robust solution for augmenting the flap bulk and may be used in cases of severe osteomyelitis of the hand.

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Section: Discussionmentioning

confidence: 99%

The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand

et al. 2019

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“…Transfer of the terminal branches of the extensor digiti minimi (EDM) and the extensor carpi ulnaris (ECU) to the UN motor branch in the forearm has been reported. In this single case, a 10-cm nerve graft had to be used and the recovery was fair [155]. It is not recommended unless there is no other option.…”

Section: Ulnar Nerve Hand Functionmentioning

confidence: 93%

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Vanaclocha‐Vanaclocha¹,

Ortiz-Criado²,

NievesSáiz-Sapena³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Successful re-innervation of proximal limb peripheral nerve injuries is rare. Axons regenerate at ~1 mm/day, reaching hand muscles by 24 months, finding them atrophied and fibrosed. Peripheral nerve injury repair is often delayed waiting for spontaneous recovery. This waiting time should not be longer than 6 months as after 18 months reinnervation will not achieve effective muscular function. When spontaneous recovery is impossible, referral too late or damage too severe, other options like a transfer from a nearby healthy nerve to the injured one must be considered. They are very successful, and the deficit in the donor site is usually minimal. The most common nerve transfers are a branch of the spinal nerve to the trapezius muscle to the suprascapular nerve, a branch of the long head of the triceps to the axillary nerve, a fascicle of the ulnar nerve to the motor branch of the biceps muscle, two branches of the median nerve to the posterior interosseous nerve and the anterior interosseous nerve to the ulnar nerve. There are many more options that can suit particular cases. Introduced in brachial plexus injury repair, they are now also applied to lower limb, to stroke and to some spinal cord injuries.

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“…Se ha documentado que el conocimiento de la distribución de ramos nerviosos puede ser un importante insumo para considerar procedimientos de transferencia nerviosa para la restitución de la inervación de la musculatura de la cintura escapular (Tubbs et al, 2006), o al mismo tiempo de procedimientos de neurectomía en caso de espasticidad (Mikalef & Power, 2017). En relación a éste tema, la literatura cuenta con una amplia descripción de distintas técnicas de transferencia nerviosa para, por ejemplo, restituir de manera exitosa la abducción del hombro a través de la reinervación del músculo deltoides, utilizando principalmente ramos motores del tríceps braquial procedentes del nervio radial (Rinker, 2015), así como el uso de ramos motores del nervio interóseo posterior para restituir la función extensora en la mano (Tung et al, 2013), situaciones que se han resuelto gracias al acabado conocimiento de las variaciones en las estructuras intervenidas.…”

Section: Ramosunclassified

Origen del Nervio Subescapular Inferior, Patrones de Ramificación y su Contribución a la Inervación del Músculo Subescapular

2020

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RESUMEN: El nervio subescapular inferior (NSI) inerva parcialmente al músculo subescapular (MSe) e inerva también al músculo redondo mayor (MRM). Diversas publicaciones determinan amplia variación en su origen en el Plexo Braquial (PB), pero existe poca evidencia de estas variaciones y del patrón de inervación del MSe y MRM en individuos latinoamericanos. El propósito de este estudio fue describir el origen del NSI en el PB, determinar número de ramos que le entrega al MSe y los patrones de ramificación. Se utilizaron 30 miembros superiores de individuos adultos, Brasileños; 13 del lado derecho y 17 del izquierdo, fijados en formaldehido al 10 %. Se disecaron las regiones axilares para exponer el fascículo posterior del plexo braquial (FPPB) y sus ramos. Se determinó si el origen del NSI era individual o procedía de un tronco común. Se cuantificó el número de ramos para el MSe, estableciendo patrones de ramificación. El NSI y sus ramos se agruparon según su origen y ramificación. En 3 de los casos (10 %) el NSI procedía de un tronco común con el nervio toracodorsal (NTD), 2 del lado izquierdo (6,6 %) y 1 del derecho (3,3 %); en 27 casos (90 %) procedía del nervio axilar (NAx), 15 del lado izquierdo (50 %) y 12 del derecho (40 %). En ningún caso, el origen fue directo del FPPB. Además, se cuantificó el número de ramos que aportaba a la inervación del MSe, observándose un promedio de 4 ramos (de 1 a 8 ramos) para el MSe. Se identificaron 4 patrones de ramificación del NSI hacia el MSe y el MRM. Tanto el origen como la distribución del NSI presentaron variaciones. Los datos aportados complementarán los conocimientos para la correcta enseñanza, el oportuno diagnóstico y la buena práctica quirúrgica de la zona axilar.

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Transfer of the Extensor Digiti Minimi and Extensor Carpi Ulnaris Branches of the Posterior Interosseous Nerve to Restore Intrinsic Hand Function: Case Report and Anatomic Study

Cited by 24 publications

References 14 publications

The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand

The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Origen del Nervio Subescapular Inferior, Patrones de Ramificación y su Contribución a la Inervación del Músculo Subescapular

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