Postoperative monitoring in free muscle transfers for reconstruction in brachial plexus injuries

Tech Hand Up Extrem Surg. 2012 Mar;16(1):48-51. doi: 10.1097/BTH.0b013e31823b5669.

Abstract

Free gracilis transfers are done for reanimation of the upper limb in traumatic total brachial plexus palsy. Because of buried nature of the free muscle and monitoring skin flap in the axillary or infraclavicular region, it is always a tricky situation for continuous and repeated monitoring to assess vascular status. Critical ischemia times vary between the muscle and monitoring skin flap because of which signs of ischemic changes in the monitoring skin flap are always delayed with respect to the muscle. We describe a novel method that uses the principle of evoked potentials from the muscle to assess the vascular status of the free muscle and detects vascular compromise early before the skin changes are apparent.

MeSH terms

  • Action Potentials
  • Brachial Plexus / injuries
  • Brachial Plexus / surgery
  • Brachial Plexus Neuropathies / surgery
  • Evoked Potentials
  • Free Tissue Flaps / blood supply*
  • Humans
  • Monitoring, Physiologic / methods*
  • Muscle, Skeletal / blood supply*
  • Muscle, Skeletal / physiopathology
  • Muscle, Skeletal / transplantation*
  • Plastic Surgery Procedures
  • Postoperative Period