Öz
30 yaşında erkek hasta, araç içi trafik kazası geçirdikten 2 saat sonra bölümümüz el cerrahisi ekibine danışıldı. Fizik muayenesinde sağ önkolda dolaşım kaybı, median ve ulnar sinirlerde yaralanma ve önkolda fleksiyon kaybı gözlendi. Ayrıca 14x7 cm. alanda cilt kaybı olduğu görüldü. Ven grefti ile brakial arter anastomozunu takiben median ve ulnar sinirler koapte edildi. Doku defektini kapatmak ve önkola fleksiyon kazandırmak için fonksiyonel latissimus dorsi kas-deri flebi dirsek ön yüzüne taşındı. Ancak ameliyat sonrası 3. ayda kasta ekskürsiyon problemi olduğu gözlendi. Bunu düzeltmek için kasın insersiyosu daha proksimal bir konuma taşındı. Ameliyat sonrası birinci yıl sonucu olarak dirsek ekleminde tam fleksiyon gözlendi. İlk ameliyat sonucu yaşanan ekskürsiyon problemi intraoperatif yetersiz kas gevşekliğine bağlandı. Bu çalışmada, optimum sonuca ulaşmak için fonksiyonel kas transferi sırasında kas gevşekliğinin yakın monitörizasyonun önemi vurgulanmıştır.
Anahtar Kelimeler
Dirsek Rekonstrüksiyonu Önkol Revaskülarizasyonu Fonksiyonel Kas Transferi Latissumus Dorsi Flebi
Kaynakça
- Chang LD, Goldberg NH, Chang B, Spence R. Elbow defect cover- 1.
- age with a one-staged, tunneled latissimus dorsi transposition
- flap. Ann Plast Surg. 1994;32:496-502.
- Chen WS. Restoration of elbow flexion by latissimus dorsi 2.
- myocutaneous or muscle flap. Arch Orthop Trauma Surg. 1990;109:117-20.
- Doi K, Ihara K, Sakamoto T, Kawai S. Functional latissimus dorsi 3.
- island pedicle musculocutaneous flap to restore finger function.
- J Hand Surg Am. 1985;10:678-84.
- Minami A, Ogino T, Ohnishi N, Itoga H. The latissimus dorsi mus- 4.
- culocutaneous flap for extremity reconstruction in orthopedic
- surgery. Clin Orthop Relat Res. 1990:201-6.
- Abu Jamra FN, Massad M, Musharafieh RC. Reconstruction of 5.
- shoulder and arm defects using the latissimus dorsi myocuta
- neous flap. A report of five cases. Scand J Plast Reconstr Surg. 1986;20:307-11.
- MacKinnon SE, Weiland AJ, Godina M. Immediate forearm re- 6.
- construction with a functional latissimus dorsi island pedicle
- myocutaneous flap. Plast Reconstr Surg. 1983;71:706-10.
- Stevenson TR, Duus EC, Greene TL, Dingman RO. Traumatic up- 7.
- per arm defect treated with latissimus dorsi muscle transposi
- tion. J Pediatr Orthop. 1984;4:111-3.
- Schottstaedt ER, Larsen LJ, Bost FC. Complete muscle transposi- 8.
- tion. J Bone Joint Surg Am. 1955;37-A:897-918; discussion, -9.
- Ma CH, Tu YK, Wu CH, Yen CY, Yu SW, Kao FC. Reconstruction of 9.
- upper extremity large soft-tissue defects using pedicled latissi
- mus dorsi muscle flaps--technique illustration and clinical out
- comes. Injury. 2008;39 Suppl 4:67-74. 10. Kawamura K, Yajima H, Tomita Y, Kobata Y, Shigematsu K,
- Takakura Y. Restoration of elbow function with pedicled latissi
- mus dorsi myocutaneous flap transfer. J Shoulder Elbow Surg. 2007;16:84-90.
Öz
A thirty year old male patient presented to our hand surgery team 2 hours after a motor vehicle accident. His physical examination revealed lack of circulation in his right forearm with totally severed median and ulnar nerves and loss of forearm flexion. Additionally, a 14 x 7 cm skin area was lost. After brachial artery anastomosis with vein graft and median and ulnar nerve coaptation, a functional latissimus dorsi musculo-cutaneous flap was transferred to maintain elbow flexion and defect coverage. However, an excursion problem occurred in the post operative third month. In order to fix this, insertio of the muscle was transferred to a more proximal position. Post operative one year result was satisfactory with the complete flexion of the elbow. This problem appears to occur due to insufficient muscle relaxation during first surgery. In this report the importance of the monitoring anaesthesia and muscle relaxation during this type of functional muscle transfer was stressed to ensure optimum results.
Anahtar Kelimeler
Elbow Reconstruction Forearm Revascularization Functional Muscle Transfer Latissimus Dorsi Flap
Kaynakça
- Chang LD, Goldberg NH, Chang B, Spence R. Elbow defect cover- 1.
- age with a one-staged, tunneled latissimus dorsi transposition
- flap. Ann Plast Surg. 1994;32:496-502.
- Chen WS. Restoration of elbow flexion by latissimus dorsi 2.
- myocutaneous or muscle flap. Arch Orthop Trauma Surg. 1990;109:117-20.
- Doi K, Ihara K, Sakamoto T, Kawai S. Functional latissimus dorsi 3.
- island pedicle musculocutaneous flap to restore finger function.
- J Hand Surg Am. 1985;10:678-84.
- Minami A, Ogino T, Ohnishi N, Itoga H. The latissimus dorsi mus- 4.
- culocutaneous flap for extremity reconstruction in orthopedic
- surgery. Clin Orthop Relat Res. 1990:201-6.
- Abu Jamra FN, Massad M, Musharafieh RC. Reconstruction of 5.
- shoulder and arm defects using the latissimus dorsi myocuta
- neous flap. A report of five cases. Scand J Plast Reconstr Surg. 1986;20:307-11.
- MacKinnon SE, Weiland AJ, Godina M. Immediate forearm re- 6.
- construction with a functional latissimus dorsi island pedicle
- myocutaneous flap. Plast Reconstr Surg. 1983;71:706-10.
- Stevenson TR, Duus EC, Greene TL, Dingman RO. Traumatic up- 7.
- per arm defect treated with latissimus dorsi muscle transposi
- tion. J Pediatr Orthop. 1984;4:111-3.
- Schottstaedt ER, Larsen LJ, Bost FC. Complete muscle transposi- 8.
- tion. J Bone Joint Surg Am. 1955;37-A:897-918; discussion, -9.
- Ma CH, Tu YK, Wu CH, Yen CY, Yu SW, Kao FC. Reconstruction of 9.
- upper extremity large soft-tissue defects using pedicled latissi
- mus dorsi muscle flaps--technique illustration and clinical out
- comes. Injury. 2008;39 Suppl 4:67-74. 10. Kawamura K, Yajima H, Tomita Y, Kobata Y, Shigematsu K,
- Takakura Y. Restoration of elbow function with pedicled latissi
- mus dorsi myocutaneous flap transfer. J Shoulder Elbow Surg. 2007;16:84-90.
Ayrıntılar
| Diğer ID | JA59HS87NH |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ağustos 2012 |
| Yayımlandığı Sayı | Yıl 2012 Cilt: 20 Sayı: 2 |