Revisión de una transposición del nervio cubital seguida de una transposición estándar fallida submuscular del nervio cubital

Revision Ulnar Nerve Transposition Following Failed Submuscular Ulnar Nerve Transposition – Standard

 

Fuente
Este artículo es originalmente publicado en:

https://www.youtube.com/watch?v=ZLvmFCYA8g8

https://youtu.be/ZLvmFCYA8g8

 

 

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Courtesy: Prof Susan Mackinnon MD
University of Washington, St Louis, MO
http://passioeducation.com/

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SURGICAL PROCEDURE
Revision Ulnar Nerve Transposition Following Failed Submuscular Ulnar Nerve Transposition
Authors: Mackinnon SE1, Yee A1
Published: August 30, 2016

Author Information
1Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

Standard Edition (160413.160708)

Failed surgical management of cubital tunnel syndrome may warrant a revision ulnar nerve transposition. Revision surgery is associated with increased technical difficulty depending on the primary procedure. The senior author’s preferred technique for management of cubital tunnel syndrome is a transmuscular ulnar nerve transposition. The technique for revision surgery incorporates methods towards a transmuscular transposition. In this case, a 23-year-old patient presented with a three-year history of significant and continuous ulnar neuropathy two-years following an anterior submuscular ulnar nerve transposition. Examination revealed ulnar intrinsic atrophy and decreased ulnar nerve sensation with normal and intact medial antebrachial cutaneous nerve sensation. Electrodiagnostic studies include small ulnar CMAP amplitude with absent SNAP and fibrillations with motor unit potentials. The scratch collapse test with ethyl chloride hierarchy revealed positive provocations in the order of the cubital tunnel, Guyon’s canal, and Struthers’ ligament. Surgical management for this case includes revision ulnar nerve transposition, supercharge anterior interosseous to ulnar motor nerve transfer for motor recovery, side-to-side bridging nerve grafts with acellularized nerve allografts from median to ulnar sensory nerves for early sensory recovery, and a flexor digitorum profundus tenodesis. This video documents the revision transposition component of this patient’s surgical management. 

Table of Contents (Standard)
00:32 Incision and Superficial Dissection
01:24 Proximal Superficial Dissection
01:47 Identifying the Ulnar Nerve Proximally and Remnant Medial Intermuscular Septum
02:22 Distal Superficial Dissection
02:32 Identifying a Branch of Medial Antebrachial Cutaneous Nerve
03:19 Identifying and Dissecting in the Interval between the Flexor Musculature
04:31 Identifying the Ulnar Nerve Distally and Distal Intermuscular Septum
05:48 Proximal Dissection through Scar Tissue
06:37 Elevating Superficial Fascia to Reveal the Pronator-Flexor Musculature
07:21 Identifying the Medial Antebrachial Cutaneous Nerve
07:51 Dissecting and Identifying the Proximal and Distal Extent of the Submuscular Transposition
08:21 Creating the Medial and Lateral Fascial Flaps
09:03 Proximal Dissection of Ulnar Nerve through Pronator-Flexor Musculature
10:02 Distal Dissection of Ulnar Nerve through Pronator-Flexor Musculature
12:10 Release of the Ulnar Nerve from Submuscular Transposition
12:26 Release of the Distal Intermuscular Septum
13:15 Creating the Transmuscular Bed
13:38 Elevating the Ulnar Nerve from Submuscular Transposition
13:52 Examining and Releasing the Medial Antebrachial Cutaneous Nerve
14:35 Neurolysis of the Ulnar Nerve and Neurolyzing the Flexor Carpi Ulnaris Branch Proximally
15:31 Resecting the Fascial Septum «T» between the Pronator-Flexor Musculature
16:02 Resecting Remnant Medial Intermuscular Septum
16:19 Elevating the Ulnar Nerve to the Transmuscular Bed
17:08 Additional Examining and Releasing the Medial Antebrachial Cutaneous Nerve
17:55 Suturing the Fascial Flaps for a Revision Transmuscular Transposition
18:22 Proximal Dissection and Release of Struthers’ Ligament
19:33 Credits

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Neuropatía cubital: evaluación y manejo / Ulnar neuropathy: evaluation and management

Fuente
Este artículo es originalmente publicado en:

http://www.ncbi.nlm.nih.gov/pubmed/27080868

http://link.springer.com/article/10.1007%2Fs12178-016-9327-x
De:

Dy CJ1,2, Mackinnon SE3.

Curr Rev Musculoskelet Med. 2016 Apr 14. [Epub ahead of print] Todos los derechos reservados para:

© Springer International Publishing AG, Part of Springer Science+Business Media

 

Abstract

Ulnar neuropathy is commonly encountered, both acutely after elbow trauma and in the setting of chronic compression neuropathy. Careful clinical evaluation and discerning evaluation of electrodiagnostic studies are helpful in determining the prognosis of recovery with nonoperative and operative management. Appreciation of the subtleties in clinical presentation and thoughtful consideration of the timing and type of surgical intervention are critical to optimizing outcomes after treatment of ulnar neuropathy. The potential need for decompression at both the cubital tunnel and Guyon’s canal must be appreciated. Supplementation of decompression with supercharged end-to-side nerve transfer can expedite motor recovery of the ulnar intrinsic muscles in the appropriately selected patient. The emergence of nerve transfer techniques has also changed the management of acute ulnar nerve injuries.

Resumen
La neuropatía cubital se encuentra comúnmente, tanto de forma aguda después de un traumatismo del codo y en el contexto de neuropatía por compresión crónica. Una cuidadosa evaluación clínica y evaluación exigente de los estudios de electrodiagnóstico son útiles para determinar el pronóstico de recuperación con un tratamiento no quirúrgico y operativa. La apreciación de las sutilezas en la presentación clínica y la consideración cuidadosa del momento y el tipo de intervención quirúrgica son fundamentales para optimizar los resultados después del tratamiento de la neuropatía cubital. Dada la posibilidad de descompresión, tanto en el túnel cubital y el canal de Guyon debe ser apreciado. La suplementación de la descompresión con la transferencia de los nervios sobrealimentado de extremo a lado puede acelerar la recuperación motora de los músculos intrínsecos cubital en el paciente seleccionado apropiadamente. La aparición de las técnicas de transferencia nervio también ha cambiado el tratamiento de lesiones agudas del nervio cubital.

KEYWORDS:

Cubital tunnel; Guyon’s canal; Ulnar nerve compression; Ulnar nerve transposition; Ulnar neuropathy

PMID:  27080868 [PubMed – as supplied by Publisher]