Applied Anatomy Of Double Functioning Free Muscle Of Adductor Longus-gracilis And Its Clinical Study On Limb Functional Reconstruction Of The Brachial Plexus Injury

Part 1 Applied anatomy of double functioning free muscle of adductor longus-gracilisOBJECTIVETo study the applied anatomy of double functioning free muscle(DFFM)of adductor longus-gracilis(AL-G)and the feasibility of its transplantation with single pedicle anastomosis,in order to provide anatomic basis for limb functional reconstruction of severe injuries of brachial plexus.MATERIALS AND METHODSNine sides of fresh lower limb specimens from adult cadavers were perfusion with red latex and lead oxide mixture through femoral artery and kept in cold storage.After thawing,the blood supply sources and branches were traced when neurovascular portal of adductor longus-gracilis were exposed.After revealing anterior branch of the obturator nerve,tracking branches of adductor longus and gracilis,cutting out adductor longus-gracilis with nerve and vascular pedicle from origin to insertion,the length and diameter of nerve and vascular pedicle of all muscles were meatured with a vernier caliper(accuracy:0.02mm)and a straightedge(accuracy:1mm).Six sides of adductor longus-gracilis were taken X-ray examination to make further observation of the vascular branches and course characteristics in muscles.RESULTSThe adductor longus and gracilis of all the nine specimens were supplied by the common pedicle derived from the deep femoral artery.The length from the starting point of the vascular pedicle to the main branch of the adductor longus and the gracilis muscle was(38.72±5.67)mm and(80.36±5.27)mm,and the starting diameter was(1.94±0.11)mm.The average length from obturator membrane to the insertion point of the adductor longus and gracilis muscle was(90.82±4.79)mm and(110.45±4.57)mm,and the total starting diameter was(2.43±0.16)mm.CONCLUSIONDouble functioning free muscle transplantation of adductor longus-gracilis transplantation with single pedicle anastomosis for limb functional reconstruction of severe injuries of brachial plexus is feasible.Part 2 Clinical study on double functioning free muscle transplantation of adductor longus-gracilis for limb functional reconstruction of the brachial plexus injuryOBJECTIVETo explore the clinical application effect of double functioning free muscle transplantation of adductor longus-gracilis with single pedicle anastomosis for limb functional reconstruction of brachial plexus injury(BPI),and to provide reference for its clinical application.METHODSTwo young male patients with upper limb sensory and motor dysfunction caused by trauma were confirmed to have total brachial plexus root avulsion injury by electromyography and surgical exploration.Preoperative chest X-ray and lung function showed good diaphragm movement and normal lung capacity.In the first stage,the contralateral adductor longus-gracilis musculocutaneous flap(thoracoscopic phrenic nerve transfer to work as power nerve)were transplanted for reconstruction of elbow flexion and thumb and finger flexion respectively.In the second stage,the ipsilateral gracilis musculocutaneous flap(motor branches of four,five and six intercostal nerve transfer to work as power nerve)were used for reconstruction of elbow extension and finger extension at the same time.RESULTSThe electromyography showed the electromyographic activity of transplanted muscles four to five months after the first phase of the operation.The voluntary contraction of the muscle was observed in six to seven months,and elbow flexion was observed in eight months.Sensory was recovered in distal forearm and the elbow range of motion was zero to one hundred and fifteen degrees after fourteen to eighteen months,with grade four to grade five minus elbow flexion muscle strength and grade three finger flexion muscle strength.CONCLUSIONDouble functioning free muscle transplantation of adductor longus-gracilis with single pedicle anastomosis is an effective techinque for limb functional reconstruction of severe injuries of brachial plexus.