The free functional muscle transfer (FFMT) is the surgical procedure aimed at reconstructing defective or deteriorated muscle function by grafting free muscles including blood vessels and nerves. Since the free gracilis transfer in the facial paralysis was introduced in 1976, there have been many studies and clinical applications of the FFMT in various donor and recipient sites in brachial plexus injury, muscle ischemic contracture, muscle defect after tumor resection, congenital muscular deficit, multiple trauma. When the reconstruction of the nerve is delayed for 9 months to 1 year after the brachial plexus injury, voluntary muscle contracture is impossible even after the nerve regeneration by the irreversible degeneration of the muscles. And it is difficult to obtain adequate function even if nerve transfer or nerve transplantation is performed because the distance to be regenerated is too long. In these cases, the FFMT has been improved the functions of the upper limb in flexion or extension of the elbow, fingers. Many good clinical results of the FFMT have been reported, so the FFMT gets much interests and attentions. The essential things for the successful outcome of the surgery are the anatomical knowledge, the skilled surgical technique and the choice of patients who can meet the indications and receive long-term rehabilitation. Recent advances in surgical techniques will result in improved results of the FFMT.
Attention ; Blood Vessels ; Brachial Plexus* ; Contracture ; Elbow ; Facial Paralysis ; Fingers ; Humans ; Ischemic Contracture ; Multiple Trauma ; Muscle, Skeletal ; Muscles ; Nerve Regeneration ; Nerve Transfer ; Rehabilitation ; Tissue Donors ; Transplants ; Upper Extremity

The term ‘Nerve Transfer’ means the transfer of a normal or nearly normal fascicle or nerve branch to an important sensory or motor nerve that has sustained irreparable proximal damage. It is a kind of salvage procedure performed when the proximal part of a peripheral nerve is totally damaged and impossible to be repaired. In case of irreparable preganglionic injury, it is difficult to recovery the nerve function by only nerve graft. In this case, the uninjured nerve around the brachial plexus could be transferred to restore the function of the upper extremities. Previous studies have reported a high recovery rate for the function of the upper limb above the elbow and recent efforts have been made to restore the function of the upper limb below the elbow including hand functions. The purpose of this article is to review the type of nerve transfer to restore upper extremity function, operative technique, outcomes and complication.
Brachial Plexus ; Elbow ; Hand ; Nerve Transfer* ; Peripheral Nerves ; Transplants ; Upper Extremity*

Brachial plexus injuries (BPI) can have devastating effects on upper extremity function, however, treatment in this injuries remains a difficult problem. Several kinds of surgical methods have been used to treat BPI, and nerve repair and nerve grafting have been traditionally used in postganglionic injury of brachial plexus. Because the several studies reported that nerve transfer to restore shoulder and elbow function has yielded superior results to historical reports for nerve grafting in partial BPI, the indication of nerve repair and nerve grafting has been decreased. Nonetheless, nerve repair and nerve grafting is still useful in focal damage in brachial plexus, such as laceration or gunshot wound and postganglionic neuroma in continuity without conduction of nerve action potential. In this paper, we described the basic concept, detailed indication and outcomes of nerve repair or nerve grafting in BPI.
Action Potentials ; Brachial Plexus* ; Elbow ; Lacerations ; Nerve Transfer ; Neuroma ; Shoulder ; Transplants* ; Upper Extremity ; Wounds, Gunshot

Brachial plexus injury is regarded as one of the most devastating injuries of the upper extremity. Accurate diagnosis is important to obtain the successful results. Basic preoperative evaluation includes simple radiography, cervical myelography. Magnetic resonance imaging, angiography, electrophysiologic studies and intraoperative studies. Furthermore, proper timing of surgery, surgical indication, plan and sufficient understanding of patients about the prognosis are the key for the satisfactory outcomes. This article provides an overview of the evaluation, diagnosis, intraoperative monitoring, and proper surgical planning for the treatment of posttraumatic brachial plexus injuries.
Angiography ; Brachial Plexus* ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Monitoring, Intraoperative ; Myelography ; Prognosis ; Radiography ; Upper Extremity

Primary cutaneous cryptococcosis is a fungal infection caused by Cryptococ cus neoformans which is frequently occurred in the immunosuppressed host. The treatment of primary cutaneous cryptococcosis is mainly fluconazole, and the prognosis is relatively good. We report a case of primary cutaneous cryptococcosis due to intravenous line on the left forearm after lumbar stenosis surgery in a patient with rheumatoid arthritis, who finally underwent second, fourth, and fifth ray amputation.
Amputation ; Arthritis, Rheumatoid* ; Constriction, Pathologic ; Cryptococcosis* ; Fluconazole ; Forearm ; Humans ; Immunocompromised Host ; Injections, Intravenous ; Prognosis ; Surgical Flaps

Extensor tendon rupture is well known complication following distal radius fracture after either conservative treatment or volar plating. However, there are not many reports in literature about concomitant ruptures of other extensor tendons. We report a case of delayed rupture of extensor pollicis longus (EPL), second extensor digitorum communis (EDC II), and extensor indicis proprius (EIP) tendons 4 weeks after volar plating for distal radius fracture. Due to the absence of EIP, EIP transfer was discouraged for EPL reconstruction. Thumb and index finger extension was restored by palmaris longus tendon graft for EPL and EDC II.
Fingers ; Radius Fractures* ; Radius* ; Rupture* ; Tendons* ; Thumb ; Transplants

When hand injuries caused by human bite are overlooked and they can progress to pyogenic arthritis. Pyogenic arthritis is difficult to treat and can make severe sequelae in the joints. We report a case of pyogenic arthritis of the hand that occurred after human bite injury in adolescent treated with wide debridement and external fixator. Our literature searches revealed that the use of external fixator is good treatment option for the treatment of pyogenic arthritis of the hand.
Adolescent* ; Arthritis* ; Bites, Human ; Debridement ; External Fixators ; Hand ; Hand Injuries ; Humans ; Joints ; Metacarpophalangeal Joint*

PURPOSE: Hand fractures can be treated conservatively in many cases, but rotation malalignment is one of the important indications for surgical treatment because of dysfunction. We performed open reduction and internal fixation in these malalignment fractures and report clinical and radiological results. METHODS: This study included 28 patients (18 male, 10 female) who had metacarpal and phalangeal fractures with rotational malalignment of finger on initial examination. Patients with combined injuries including open soft tissue damage or multiple fractures were excluded. Mean age was 36.1 years and average follow-up period was 14.6 months. Perioperative extent of rotation and correction during the follow-up, union on the radiographs, Range of motion, disability of the arm, shoulder and hand (DASH) score, and pinch power at the last follow-up were evaluated. RESULTS: Average corrected angulation of rotation was 11.9° and no patient showed scissoring appearance of fingers at the last follow-up. All patients showed solid bony union on the radiographs during the follow-up. The average of total active motion of the injured fingers were average 254°, average DASH score was 3.2 and average pinch power was 3.0 kg at the last follow-up. CONCLUSION: Clinical and radiologically satisfactory results were obtained in all patients. Care should be taken not to overlook the rotational misalignment after fracture of the hand, and surgical treatment should be considered to ensure correct reduction and fixation.
Arm ; Finger Phalanges ; Fingers ; Follow-Up Studies ; Fractures, Multiple ; Hand ; Humans ; Male ; Metacarpal Bones ; Range of Motion, Articular ; Shoulder

PURPOSE: To assess union and complication rates associated with the use of 2 small diameter headless compression screws and volar wedge bone grafting for the treatment of scaphoid fracture waist nonunions with collapse. METHODS: A total of 12 patients (11 male and 1 female) at an average age of 32.5 years were treated with open reduction and internal fixation with 2 small diameter headless compression screws for scaphoid nonunions with a mean follow-up of 11 months. Tricortical wedge shaped autograft were harvested from the iliac crest and placed into the nonunion site to restore length and alignment in all patients. Union was determined by radiographs and computed tomography, and scapholunate and radiolunate angles, and height-to-length ratio were calculated on final radiographs and follow-up computed tomography. RESULTS: All 12 scaphoids united with a mean time for 2.8 months. The mean postoperative scapholunate angle was significantly reduced from 73° preoperatively to 56° postoperatively. The mean radiolunate angle was significantly improved from 21° from neutral preoperatively to 12° postoperatively. The height-to-length ratio was also demonstrated significant improvement from 0.73 preoperatively to 0.60 postoperatively. No hardware problems were identified and no revision procedures have been necessary. CONCLUSION: Our results indicate that the use of 2 small diameter headless compression screws with volar structural bone graft stabilizes the fracture for predictable union, while reducing the deformity reliably from a collapsed scaphoid nonunion. The presented technique is safe and effective, and may provide superior biomechanical stability, especially against the torsional force.
Autografts ; Bone Transplantation ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Male ; Torsion, Mechanical ; Transplants

PURPOSE: To determine clinical and radiographic results of iliac bone grafting with Kirschner wire fixation for treatment of scaphoid nonunions. METHODS: A total of 13 patients who had scaphoid nonunion treated with iliac bone grafting and Kirschner wire fixation between October 2007 and January 2016 were enrolled as subjects of this study. Their clinical results were evaluated, including range of motion of the wrist joint and modified Mayo wrist score. Radiographic results including lateral intrascaphoid angle and scapholunate angle were also assessed. RESULTS: Bony union was achieved in 11 (84.6%) of 13 cases. Modified Mayo wrist score was improved from 64.0 preoperatively to 87.5 postoperatively. Average intrascaphoid angle was improved from 39.5° preoperatively to 27.2° postoperatively while scapholunate angle was improved from 66.0° preoperatively to 55.1° postoperatively. CONCLUSION: Iliac bone graft with Kirschner wire fixation provided good clinical and radiographic results. Therefore, iliac bone graft with Kirschner wire fixation can be considered as a good treatment option for scaphoid nonunion.
Bone Transplantation ; Humans ; Range of Motion, Articular ; Transplants* ; Wrist ; Wrist Joint