ReoperationRate after Free Functional Muscle Transfers in Traumatic brachial plexus injury
Pichitchai Atthakomol, MD, Medical Doctor
SezaiÖzkan, MD, Medical Doctor
Kyle R. Eberlin, MD, Medical Doctor
Sang-Gil Lee, MD, Medical Doctor
Jonathan Winograd, MD, Medical Doctor
Neal C. Chen, MD, Medical Doctor
Presenter:Pichitchai Atthakomol, MD
Biographical sketch presenter:
- Research fellow at Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Instructor in Hand and Microsurgery, Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (May 2015– present). Please see attached CV for additional information.
Contact person:
Pichitchai Atthakomol, MD
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai
University, Chiang Mai, Thailand; 110 Intavaroros Road, Muang District Chiang Mai, Thailand 50200
E-mail:
Phone: +1 617 480 6540
Purpose:
Free functional muscle transfer remains the preferred optionfor upper limb reconstruction in patients with complete traumatic brachial plexus injury. Few studies have investigated revision surgeries followingfree functional muscle transfers to restore upper extremity function. The objective of this study is to report the unplanned reoperation rate and factors associated with reoperation after free functional muscle transfers in patients with traumatic brachial plexopathy.
Methods:
We queried the research database of the Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, MA, USA and identified 25 patients who underwent functional muscle transfer. We reviewed their medical charts to record patient, injury, and treatment characteristics. All 25 patients had a free functional muscle transfer of the gracilis muscle.
Results:
The reoperation rate after free functional muscle transfers was 14 out of 25 (56%).Reoperation included 4/14 for vascular compromise, 2/14 for wound problems, and 8/14 for retensioning of the flap. Bivariate analysis did not demonstrate anyfactorsassociated with reoperation after a free functional gracilis transfer. A multivariable analysis was not performed due to the low number of surgeries.
Conclusions:
Despite promising results of free functionalgracilis transfers, reoperation may be required in the majority offree functional muscle transfer procedures performed for traumatic brachial plexus injury. Surgeon awareness of the most common causes of reoperation after free functional muscle transfer procedures might better inform patients and may reduce the rate of reoperation.