Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation

Wide-awake surgery is transforming many areas of hand surgery. We report a distinctive case of an avulsion near total amputation of the right dominant arm, which required emergent shaft humerus fracture fixation and brachial artery repair with a vein graft. Three months post-injury, the patient unde...

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Autores principales: Sankaran, Ajeesh, Thushara, K R, Ajaykumar, V, Mohankumar, E G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536512/
https://www.ncbi.nlm.nih.gov/pubmed/36225501
http://dx.doi.org/10.7759/cureus.28837
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author Sankaran, Ajeesh
Thushara, K R
Ajaykumar, V
Mohankumar, E G
author_facet Sankaran, Ajeesh
Thushara, K R
Ajaykumar, V
Mohankumar, E G
author_sort Sankaran, Ajeesh
collection PubMed
description Wide-awake surgery is transforming many areas of hand surgery. We report a distinctive case of an avulsion near total amputation of the right dominant arm, which required emergent shaft humerus fracture fixation and brachial artery repair with a vein graft. Three months post-injury, the patient underwent long segment nerve grafts of the median and ulnar nerves, with pectoralis major to biceps transfer for elbow flexion reconstruction. Since the patient failed to gain any functional movement of the elbow, we explored the transfer under wide-awake local anaesthesia using lignocaine and adrenaline. Four months after the wide-awake release, the patient had gained 70 degrees elbow flexion against gravity and 110 degrees with gravity eliminated. On the Waikakul scale, the result was categorized as 'Good'. Wide-awake anaesthesia allowed sufficient release of a large muscle transfer in a prior traumatised zone with a satisfactory result.
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spelling pubmed-95365122022-10-11 Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation Sankaran, Ajeesh Thushara, K R Ajaykumar, V Mohankumar, E G Cureus Orthopedics Wide-awake surgery is transforming many areas of hand surgery. We report a distinctive case of an avulsion near total amputation of the right dominant arm, which required emergent shaft humerus fracture fixation and brachial artery repair with a vein graft. Three months post-injury, the patient underwent long segment nerve grafts of the median and ulnar nerves, with pectoralis major to biceps transfer for elbow flexion reconstruction. Since the patient failed to gain any functional movement of the elbow, we explored the transfer under wide-awake local anaesthesia using lignocaine and adrenaline. Four months after the wide-awake release, the patient had gained 70 degrees elbow flexion against gravity and 110 degrees with gravity eliminated. On the Waikakul scale, the result was categorized as 'Good'. Wide-awake anaesthesia allowed sufficient release of a large muscle transfer in a prior traumatised zone with a satisfactory result. Cureus 2022-09-06 /pmc/articles/PMC9536512/ /pubmed/36225501 http://dx.doi.org/10.7759/cureus.28837 Text en Copyright © 2022, Sankaran et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Orthopedics
Sankaran, Ajeesh
Thushara, K R
Ajaykumar, V
Mohankumar, E G
Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation
title Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation
title_full Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation
title_fullStr Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation
title_full_unstemmed Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation
title_short Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation
title_sort wide-awake tenolysis of a pectoralis major to biceps transfer after near total arm avulsion amputation
topic Orthopedics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536512/
https://www.ncbi.nlm.nih.gov/pubmed/36225501
http://dx.doi.org/10.7759/cureus.28837
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