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21st RCD 2014
Regional Conference of Dermatology (Asian-Australasian) incorporating the 6th Annual Meeting of the Asian Academy of Dermatology and Venereology 9th to 12th April 2014 Furama Hotel Danang, Vietnam.
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Friday, January 18, 2013
Tendon Transfers
Paralysis of the upper and lower extremity produces major functional impairment. Tendon transfers are a viable surgical option for reconstruction following paralysis. By transferring a functional muscle-tendon unit to a paralyzed muscle-tendon unit, the functional unit inherits and restores the function of the paralyzed unit. During the surgical planning for the appropriate management, tendon transfers are always an available option when the time criteria for nerve transfers following injury has passed or if the nerve transfer does not produce adequate functional recovery. Additional, tendon transfers can be used as adjunct procedures and improve the functional outcome following nerve transfers.
Due to the availability of tendon transfers, be aware in difficult cases that involve multi-level nerve injuries, not to “burn bridges” during the surgical planning. Tendon transfers differ from nerve transfers in that the patient can expect immediate improvement of function, unlike nerve transfers which can take several years for the plateau of functional recovery. This can be important to the patient when discussing their needs during the pre-operative assessment.
Due to the availability of tendon transfers, be aware in difficult cases that involve multi-level nerve injuries, not to “burn bridges” during the surgical planning. Tendon transfers differ from nerve transfers in that the patient can expect immediate improvement of function, unlike nerve transfers which can take several years for the plateau of functional recovery. This can be important to the patient when discussing their needs during the pre-operative assessment.
Title: Flexor Digitorum Profundus Tenodesis of Median to Ulnar-innervated Tendons.
Published: 6/27/2011, Updated: 6/27/2011.
Author(s): Andrew Yee BS, Susan E. Mackinnon MD. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Surgical Tutorial – Flexor Digitorum Profundus Tenodesis (Median FDP to Ulnar FDP). For paralysis of ulnar-innervated flexor digitorum profundus (FDP) to the ring and small finger, tenodesis of the ulnar-innervated FDP tendons will allow the median-innervated FDP to drive the function of the ulnar-innervated FDP function. Specifically, the ulnar-innervated FDP tendons are sutured to the FDP tendon to the long finger, while the FDP tendon to the index finger is not included in this tenodesis. In this specific case, the patient had a complete ulnar nerve injury and the FDP tenodesis was performed in conjunction with the anterior interosseous to ulnar motor nerve transfer, 3rd webspace to ulnar sensory nerve transfer, and Guyon's canal release.
Author(s): Andrew Yee BS, Susan E. Mackinnon MD. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Surgical Tutorial – Flexor Digitorum Profundus Tenodesis (Median FDP to Ulnar FDP). For paralysis of ulnar-innervated flexor digitorum profundus (FDP) to the ring and small finger, tenodesis of the ulnar-innervated FDP tendons will allow the median-innervated FDP to drive the function of the ulnar-innervated FDP function. Specifically, the ulnar-innervated FDP tendons are sutured to the FDP tendon to the long finger, while the FDP tendon to the index finger is not included in this tenodesis. In this specific case, the patient had a complete ulnar nerve injury and the FDP tenodesis was performed in conjunction with the anterior interosseous to ulnar motor nerve transfer, 3rd webspace to ulnar sensory nerve transfer, and Guyon's canal release.
Title: Tendon Transfers for Radial Nerve Palsy - PT to ECRB, FCR to EDC, PL to EPL
Published: 12/13/2011, Updated: 12/13/2011.
Author(s): Lawrence Zieske BA, Andrew Yee BS, Susan E. Mackinnon MD. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Surgical Tutorial – Median to Radial Nerve Tendon Transfers: PT to ECRB, FCR to EDC, PL to EPL.
Tendon transfers are an available option for reconstructing wrist and finger/thumb extension following radial nerve injury when nerve transfers are contra-indicated. The donor median-innervated tendons are used to reconstruct the recipient radial-innervated tendons. This tutorial describes the following tendon transfers: (1) pronator teres (PT) to extensor carpi radialis brevis (ECRB), (2) flexor carpi radialis (FCR) to extensor digitorum communis (EDC), and (3) palmaris longus (PL) to extensor pollicis longus (EPL). In this specific case, the patient had a left humeral fracture and lost complete radial nerve function. He consulted with our institution six months following the injury. While he was within the time limitation of nerve transfers, he elected for tendon transfers for radial nerve palsy.
Published: 12/13/2011, Updated: 12/13/2011.
Author(s): Lawrence Zieske BA, Andrew Yee BS, Susan E. Mackinnon MD. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Surgical Tutorial – Median to Radial Nerve Tendon Transfers: PT to ECRB, FCR to EDC, PL to EPL.
Tendon transfers are an available option for reconstructing wrist and finger/thumb extension following radial nerve injury when nerve transfers are contra-indicated. The donor median-innervated tendons are used to reconstruct the recipient radial-innervated tendons. This tutorial describes the following tendon transfers: (1) pronator teres (PT) to extensor carpi radialis brevis (ECRB), (2) flexor carpi radialis (FCR) to extensor digitorum communis (EDC), and (3) palmaris longus (PL) to extensor pollicis longus (EPL). In this specific case, the patient had a left humeral fracture and lost complete radial nerve function. He consulted with our institution six months following the injury. While he was within the time limitation of nerve transfers, he elected for tendon transfers for radial nerve palsy.
Title: Tarsal Tunnel Release
Published: 10/13/2011, Updated: 10/13/2011.
Author(s): Andrew Yee BS, Susan E. Mackinnon MD.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Surgical Tutorial – Tarsal Tunnel Release. Tarsal tunnel syndrome describes the compression of the tibial nerve through the tarsal tunnel which results in pain and numbness in the plantar aspect of the foot. The tibial nerve has three major branches which include the calcaneal, medial plantar, and lateral plantar nerve branches. There are two primary structures responsible for compression of the tibial nerve: (1) flexor retinaculum and (2) a septum that compartmentalizes the medial and lateral plantar nerves and the overlying fascia of the abductor hallucis muscle. The tarsal tunnel release involves releasing these structures. In this case, the patient had a traumatic injury to the lower leg, which required open reduction and internal fixation. The patient had pain and numbness in the tibial nerve distribution along with Tinel's sign and positive scratch collapse at the tarsal tunnel.
Surgical Tutorial – Tarsal Tunnel Release. Tarsal tunnel syndrome describes the compression of the tibial nerve through the tarsal tunnel which results in pain and numbness in the plantar aspect of the foot. The tibial nerve has three major branches which include the calcaneal, medial plantar, and lateral plantar nerve branches. There are two primary structures responsible for compression of the tibial nerve: (1) flexor retinaculum and (2) a septum that compartmentalizes the medial and lateral plantar nerves and the overlying fascia of the abductor hallucis muscle. The tarsal tunnel release involves releasing these structures. In this case, the patient had a traumatic injury to the lower leg, which required open reduction and internal fixation. The patient had pain and numbness in the tibial nerve distribution along with Tinel's sign and positive scratch collapse at the tarsal tunnel.
Title:Tibial Nerve Decompression at the Soleus.
Published: 3/28/2011, Updated: 3/28/2011.
Author(s): Susan E. Mackinnon MD, Andrew Yee BS. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Surgical Tutorial – Tibial Nerve Decompression at the Soleus. Compression of the tibial nerve by the tendinous leading-edge of the soleus is rare but under recognized. The tibial nerve is decompressed by dividing the soleus arch found deep within the lower leg. The surgical approach involves proceeding between the lateral and medial gastrocnemius muscles. The soleus muscle is then identified deep to the gastrocnemius muscles, at which the tibial nerve is identified proximal to this muscle. The tibial nerve dives deep to the soleus arch, at which the compression point is found.
Published: 3/28/2011, Updated: 3/28/2011.
Author(s): Susan E. Mackinnon MD, Andrew Yee BS. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Surgical Tutorial – Tibial Nerve Decompression at the Soleus. Compression of the tibial nerve by the tendinous leading-edge of the soleus is rare but under recognized. The tibial nerve is decompressed by dividing the soleus arch found deep within the lower leg. The surgical approach involves proceeding between the lateral and medial gastrocnemius muscles. The soleus muscle is then identified deep to the gastrocnemius muscles, at which the tibial nerve is identified proximal to this muscle. The tibial nerve dives deep to the soleus arch, at which the compression point is found.
Title: Superficial Peroneal Nerve Release in the Lower Leg
Published: 10/13/2011, Updated: 10/13/2011.
Surgical Tutorial – Superficial Peroneal Nerve Release in the Lower Leg. Symptoms of a compressed superficial peroneal nerve in the lower leg includes numbness and tingling in the dorsal aspect of the foot and lateral aspect of the lower leg. These symptoms can be exaggerated when the peroneal nerve is under tension during movements of the leg and foot. Compression of the superficial peroneal nerve occurs due to the transverse crural ligament and the tight superficial fascia that encapsulates he lower leg musculature. The superficial peroneal nerve has a course just deep to this superficial fascia and exits superficially distal to the transverse crural ligament. Release of this fascia and ligament will decompress the superficial peroneal nerve. Other known areas of peroneal nerve compression include the common peroneal nerve at the fibular head and the deep peroneal nerve in the foot by the extensor hallucis brevis.
Published: 10/13/2011, Updated: 10/13/2011.
Surgical Tutorial – Superficial Peroneal Nerve Release in the Lower Leg. Symptoms of a compressed superficial peroneal nerve in the lower leg includes numbness and tingling in the dorsal aspect of the foot and lateral aspect of the lower leg. These symptoms can be exaggerated when the peroneal nerve is under tension during movements of the leg and foot. Compression of the superficial peroneal nerve occurs due to the transverse crural ligament and the tight superficial fascia that encapsulates he lower leg musculature. The superficial peroneal nerve has a course just deep to this superficial fascia and exits superficially distal to the transverse crural ligament. Release of this fascia and ligament will decompress the superficial peroneal nerve. Other known areas of peroneal nerve compression include the common peroneal nerve at the fibular head and the deep peroneal nerve in the foot by the extensor hallucis brevis.
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