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Trapezius Elbow Flexo-plasty: A Novel Technique to Restore Shoulder and Elbow Function in Late Preganglionic Pan plexus injuries
Khalid Masood, MBBS, FCPS, FEBHS, MRCS
Hand and Upper Limb Surgery Center, Lahore, Pakistan, Pakistan
The objective of this study is to share our experience of single muscle transfer to achieve abduction at shoulder and flexion at elbow for flail upper limb in late pan plexus injuries (C5-T1 roots avulsion) when options are negligible.
Methods: We managed 42 cases of pre-ganglionic pan plexus injuries during last 4.5 years. Mean duration of presentation was 3.5 years after injury. All patients were having flail limb with zero power of all muscles of upper limb including latissimus dorsi and pectoralis major. Mean age of the patients was 32 years including 3 females. Minimum age was 14 years. We lifted upper and middle parts of trapezius muscle from its site of insertion and transferred to the Biceps tendon with the help of intervening Tensor Facia Lata graft. In addition, Levator Scapulae was transferred to the Supraspinatus. An improvised splint was applied to keep the shoulder and elbow at 90 degree for 04-6 weeks. Assisted movements followed by active physiotherapy was started at 06 weeks.
Maximum range of movements was achieved within 6-9 months. 39 (91%) patients showed improvement. On the basis of achieved movements and muscle strength 11 patients showed very good, 19 good, 06 fair results while 04 patients showed poor results those were improved by adjusting tension in secondary procedure. 03 patients didn't show any improvement. On average, 62 degrees of abduction at shoulder and 68 degrees of flexion at elbow was achieved with mean <_ M3 power by 12 months. Additional procedures were performed at wrist and fingers as per patient's need.
Conclusion: Trapezius transfer with the help of Tensor Fascia Lata graft to the Biceps tendon is a useful option to achieve reasonable movements at shoulder and elbow in patients presented with late pan-plexus injuries with flail upper extremity.
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