2006 - UZ Leuven

vascularized ulnar nerve graft and secondary free latissimus dorsitransfer), in 4 patients elbow/wrist and finger flexion (direct intercostaltransfer to latissimus dorsi) and in 1 patient wrist and finger extension(intercostal transfer to latissimus dorsi) were reconstructed. Criteria forevaluation were the MRC-scale for power and active range of motion.Results: Functional elbow flexion (> 90°, M³) could be reconstructed in75 % of patients especially if residual but inadequate muscle functionis present (augmentation indication). Functional wrist and fingerflexion could be reconstructed only in 6% of cases. Reconstruction ofelbow, wrist and finger flexion with one transfer does not provide anyacceptable functional result.Conclusion: Especially in complete brachial plexus lesions freefunctional muscle transfer often is the only treatment option. By goodpatient selection satisfactory results can be achieved for elbow flexion.Up till now reconstruction at the forearm and hand level givesdisappointing results. A higher number of axon, as provided by thecontralateral C7 transfer, may lead to better results. This is the topic ofan ongoing study.HIERNER R., BETZ A., REYNDERS P., BERGER A.: Major limbreplantation at the lower extremity – still a worthwhile technique ?Chirurgica 2006; 101: 22.Introduction: As a result of modern therapeutic and technologicaladvances, the surgeon has the ability to salvage even the mostseverely injured lower limbs. However, the success of replantationnowadays is no longer evaluated simply on the basis of restoring theviability but also on 1) the risk for the patient during and afterreplantation, and 2) the functional and aesthetic outcome, and 3) timeof unfit of work and social reintegration.Material and method: Patient selection is based on an algorithmdeveloped upon personal experience and an extensive literaturereview. 14 patients presenting a total unilateral (n = 4), total bilateral(n = 2) and subtotal unilateral (n = 8) lower leg amputation underwentreplantation in our institution. The patient`s age ranged from 9 to 55years (average: 30,2). There was 1 child (male), 4 female and 9 malepatients. In one of the bilateral injuries bilateral normotopicreplantation was done. In the second case only unilateral normotopicreplantation was possible.Results: All replanted lower legs survived. Using CHEN`sclassification the functional results can be given as follows: Stage I66,6%, Stage II 25% (thus a "functional extremity" could bereconstructed in 91,6%), stage III 8,4% and stage IV 0%. Socialreintegration was achieved within 8 to 10 months after replantation. 4to 7 secondary operations were carried out in every patient in order to79