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Postoperative Monitoring in Free Muscle Transfers for Reconstruction in Brachial Plexus Injuries

Dodakundi, Chaitanya MBBS, MS Orth; Doi, Kazuteru MD, PhD; Hattori, Yasunori MD, PhD; Sakamoto, Soutetsu MD; Yonemura, Hiroshi MD, PhD; Fujihara, Yuki MD

Techniques in Hand & Upper Extremity Surgery:
doi: 10.1097/BTH.0b013e31823b5669

Free gracilis transfers are done for reanimation of the upper limb in traumatic total brachial plexus palsy. Because of buried nature of the free muscle and monitoring skin flap in the axillary or infraclavicular region, it is always a tricky situation for continuous and repeated monitoring to assess vascular status. Critical ischemia times vary between the muscle and monitoring skin flap because of which signs of ischemic changes in the monitoring skin flap are always delayed with respect to the muscle. We describe a novel method that uses the principle of evoked potentials from the muscle to assess the vascular status of the free muscle and detects vascular compromise early before the skin changes are apparent.

Author Information

Department of Orthopaedics, Ogori Daiichi General Hospital, Yamaguchi, Japan

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Kazuteru Doi, MD, PhD, Department of Orthopaedics, Ogori Daiichi General Hospital, 862-3, Shimogo Ogori, Yamaguchi 754-0002, Japan. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.