Brachial Plexus Injury
Conditions
Keywords
brachial plexus injury, brachial plexus palsy, free functional muscle transfer, arteriovenous loop graft, subclavian artery injury, axillary artery injury
Brief summary
Free functional muscle transfer (FFMT) using the gracilis muscle as a donor muscle has become a standard treatment for reconstructing late-onset brachial plexus injuries. Successful implementation of this procedure relies on the availability of functional donor vessels in the injured limb to supply the muscle flap. However, some brachial plexus injuries are accompanied by subclavian or axillary artery injuries, which compromise the viability of the muscle flap due to insufficient vascular supply. To address this, arteriovenous (AV) loop grafts have been employed to extend donor vessels to the flap and have been utilized in various body regions, including the upper extremity. Despite their widespread use, AV loop grafts have not been previously utilized in FFMT for late-onset brachial plexus injuries with concurrent subclavian or axillary artery injuries. This study aimed to assess the feasibility of this surgical approach and report the long-term outcomes of the procedure.
Interventions
PROCEDUREArteriovenous loop graft
Using saphenous vein graft to create an arteriovenous loop from the common carotid artery to the external jugular vein, providing vascular supply for a free functional gracilis muscle flap in patients with late-onset brachial plexus injury with concomitant subclavian or axillary artery injury.
Sponsors
Siriraj Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Late-onset brachial plexus injury patient with concomitant subclavian or axillary artery injury
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age equal or more than 20 years old * Patients with brachial plexus injury with depletion of blood flow to the injured limb which confirmed by abnormal computed tomography arteriogram
Exclusion criteria
* Patients who had sufficient thoraco-acromial or thoraco-dorsal artery blood flow for standard free functional muscle transfer operation without the need of an AV loop graft
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Viability of the flap | 1 month | Survival of the flap after the surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Motor power | 12 months, 18 months | Medical Research Council (MRC) grading for motor power assessment |
| Complications | 1 month | Bleeding, infection, blood transfusion, stroke, embolism, thrombosis |
| Operative time | 1 month | Total operative time including flap revision surgery or other related complications |
Countries
Thailand
Outcome results
None listed