PubMed Health⌕ Search

Biomedical subjects

J A Bertelli

Publications and source records attributed to J A Bertelli.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of scaphoid non-unions by a palmar approach with vascularised bone graft harvested from the thumb.

Ten patients with scaphoid non-unions which had been present for longer than 2 years were treated using a vascularised bone graft harvested from the thumb and pedicled on the first dorsal metacarpal artery. Bone harvesting and grafting were performed by a single palmar approach. Concomitant cancellous bone graft was not used. Bone healing was confirmed by CT scans in nine of the ten patients. Persistence of the non-union was observed in one patient who was the oldest in this series, had the longest standing non-union and was a heavy smoker. Twelve months after surgery, nine of the ten patients had significant pain relief with an improved range of motion and grip strength.

Adult↗
PubMed2005

Brachialis muscle transfer to the forearm muscles in obstetric brachial plexus palsy.

Tendon transfers are frequently needed to improve hand function in obstetric brachial plexus injuries. The reconstruction cannot always be achieved using local donor transfers in the forearm as these are not always available. In such cases, we propose the use of the brachialis muscle as a useful donor for transfer. Five adolescents with obstetric brachial plexus palsy were operated on to reconstruct wrist extension and/or pronation using the brachialis muscle transfer to the pronator teres (n=1), extensor carpi radialis brevis (n=1) and extensor carpi radialis longus (n=3). Twelve months after surgery, average active motion recovery was 20 degrees for wrist extension and 14 degrees for pronation. Active and passive range of motion was similar.

Adolescent↗
PubMed2005

Variation in nerve autograft length increases fibre misdirection and decreases pruning effectiveness: an experimental study in the rat median nerve.

OBJECTIVES: In the clinical set, autologus nerve grafts are the current option for reconstruction of nerve tissue losses. The length of the nerve graft has been suggested to affect outcomes. Experiments were performed in the rat in order to test this assumption and to detect a possible mechanism to explain differences in recovery. METHODS: The rat median nerve was repaired by ulnar nerve grafts of different lengths. Rats were evaluated for 12 months by behavioural assessment and histological studies, including ATPase myofibrillary histochemistry and retrograde neuronal labelling. RESULTS: It was demonstrated that graft length interferes in behavioural functional recovery that here correlates to muscle weight recovery. Short nerve grafts recovered faster and better. Reinnervation was not specific either at the trunk level or in the muscle itself. The normal mosaic pattern of Type I muscle fibres was never restored and their number remained largely augmented. An increment in the number of motor fibres was observed after the nerve grafting in a predominantly sensory branch in all groups. This increment was more pronounced in the long graft group. In the postoperative period, about a 20% reduction in the number of misdirected motor fibres occurred in the short nerve graft group only. CONCLUSION: Variation in the length of nerve grafts interferes in behavioural recovery and increases motor fibres misdirection. Early recovery onset was related to a better outcome, which occurs in the short graft group.

Adenosine Triphosphatases↗
PubMed2004

The towel test: a useful technique for the clinical and electromyographic evaluation of obstetric brachial plexus palsy.

The towel test consists of covering an infant's face with a towel and seeing if he/she can remove it with either arm. In this study it has been used to aid the clinical and electromyographic assessment of 21 infants with obstetric brachial plexus palsy. At 2 to 3 months, none of the 21 infants succeeded in removing the towel, either with their normal or affected arm. At 6 months, all the infants succeeded in removing the towel with their normal arm, but 11 could not with their affected arm, and the same was observed at a further assessment at 9 months. The towel test is a reliable technique for evaluating children with obstetric brachial plexus injuries.

Brachial Plexus↗
PubMed2001

Hemidigital resection with collateral ligament transplantation in the treatment of macrodactyly: a case report.

Macrodactyly is a rare congenital anomaly of the hand that is difficult to treat. We describe a new technique consisting of hemidigital, longitudinal, and transverse en bloc resection with collateral ligament transplantation to the proximal interphalangeal joint that we used in a case of macrodactyly. Four years after the procedure the digit's appearance was largely improved with preservation of complete motion at the proximal interphalangeal joint. Transplantation of the collateral ligament ensured a stable joint. Fingertip sensibility was maintained.

Adult↗
PubMed2000

Brachial plexus dorsal rhizotomy in the treatment of upper-limb spasticity.

OBJECT: This study was conducted to evaluate the effects of dorsal rhizotomy on upper-limb spasticity, functional improvement, coordination, and hand sensibility. METHODS: Fifteen spastic upper limbs in 13 patients were selected and prospectively studied. Brachial plexus dorsal rhizotomy was performed in which two, three, or four dorsal roots were completely sectioned. Patients were followed up for at least 12 months after surgery; the mean follow-up period was 15.6 months and the maximum period was 30 months. A remarkable relief of spasticity was observed in all cases. Recurrence was observed in only one patient and was caused by insufficient dorsal root section. Functional improvement was observed in all cases, and functional improvement in the hand was found to be related to the presence of active finger extension in the preoperative period. Even when extended dorsal root section was performed, no hand anesthesia, either total or partial, was observed. No patient lost movement ability in the postoperative period, and no ataxic limbs were observed. CONCLUSIONS: Brachial plexus dorsal rhizotomy is very effective as a treatment for upper-limb spasticity and results in functional improvement without loss of sensation in the hand.

Adolescent↗
PubMed1999

Cross-chest radial nerve transfer in brachial plexus injuries. Experimental and anatomical basis.

Brachial plexus avulsion injuries are devastating injuries to the upper limb, and nerve transfer remains the only option in reconstruction. Despite the encouraging results concerning recovery of shoulder and elbow function, no option is available for treatment of the paralytic hand. In rats, we sectioned the radial nerve in the elbow region and transferred it across the chest to reinnervate the lesioned contralateral medial cord of the brachial plexus. Rats were then evaluated for motor and sensory recovery, electrophysiologically, behaviorally and morphologically. Forepaw functional recovery was estimated to be 90%. In cadavers, the radial nerve and profunda brachii artery were dissected. It was observed that the radial nerve vascularized by the profunda brachii artery was able to reach the contralateral brachial plexus distal to the shoulder region without nerve grafts. After sectioning the radial nerve, sensory loss is minimal and motor palsy can be easily restored by tendon transfers. The results of tendon transfer for radial nerve palsy are better than for any other nerve. Cross-chest radial nerve transfer might be of clinical interest in the reconstruction of hand function in entire injury to the brachial plexus.

Analysis of Variance↗
PubMed1999

Sensitive areolar reconstruction in using a neurocutaneous island flap based on the medial antebrachial cutaneous nerve.

Sensory reconstruction has recently been stressed in breast reconstruction. However, there are no reports concerning the reconstruction of a sensitive areola. The bilateral reconstruction of a sensitive areola using a neurocutaneous flap based on the medial antebrachial cutaneous nerve is reported. The flap was harvested from the distal third of the forearm as an island flap and tunneled to reach the apex of the new breast, which was previously reconstructed using a 135-cc, gel-filled, silicone prosthesis covered by a latissimus dorsi myocutaneous flap. Six months later, fine sensibility in the reconstructed areola was demonstrated. The patient could perceive light touch, pain, and 14 mm two-point discrimination. At 2 months after surgery, 50 percent of cutaneous faulty stimulus location was observed. However, at 4 and 6 months after surgery, faulty location disappeared. Six months after harvesting the medial antebrachial cutaneous nerve, the sensory deficit was minimal; it included a hypoesthesic zone of 4 to 7 cm and an anesthesic zone of 2.5 to 5 cm on the middle third of the forearm. Fifteen months after the procedure, no hypoesthesic zone was observed; only a 2 to 3 cm anesthesic zone on the proximal medial side of the forearm existed. This sensory deficit passed unnoticed by the patient. The technique developed here is a refinement in breast reconstruction, and we think it should be used in selected patients.

Adult↗
PubMed1999

Selective motor hyperreinnervation by using contralateral C-7 motor rootlets in the reconstruction of an avulsion injury of the brachial plexus. Case report.

Brachial plexus avulsion injuries are a clinical challenge. In recent experimental studies the authors have demonstrated the high degree of muscle reinnervation attained when a C-4 motor rootlet was directly connected to the musculocutaneous nerve. This degree of reinnervation was attributed to the good chance that a muscle fiber can be reinnervated by a motor fiber when the number of regenerating motor neurons is increased and when competitive sensory fibers are excluded from the process. The authors present the first clinical case in which this phenomenon has been observed. This 26-year-old man, who was involved in an automobile accident, presented with an upper brachial plexus avulsion, for which he underwent operation 4 months later. The axillary and suprascapular nerves were directly surgically connected to the motor rootlets of the C-7 contralateral root by using two cables of sural nerve graft. Two years postsurgery, the patient was able to perform shoulder abduction of 120 degrees and hold an 800-g weight at 90 degrees. These results are encouraging, and in selected patients motor rootlet transfer might prove to be a useful surgical strategy.

Adult↗
PubMed1998

A surgical approach for concomitant spinal cord and brachial plexus surgery: an anatomical study.

Spinal cord surgery is not the current treatment for brachial plexus avulsion injuries. However, several experimental and a few clinical cases have been reported with promising results. This surgical strategy in the near future, might prove to be useful. Different simultaneous anatomical approaches to the brachial plexus and spinal cord were studied in attempt to discover the best route to be used in the surgical reconstruction of avulsion lesions of the brachial plexus by spinal cord surgery. Eleven fresh subjects were used to compare: a) simultaneous dorsal approaches to the brachial plexus and spinal cord, b) the dorsal approach to the spinal cord and the anterior approach to the brachial plexus, c) a dorsal approach to the spinal cord combined with a dorsal approach through the triceps muscle to the terminal branches of the brachial plexus and d) a purely anterior approach to the spinal cord and brachial plexus. During the study, special attention was paid to the length of the grafts needed for repair, the possibility of entire exposure of the brachial plexus and the possibility of performing concomitant nerve transfers. As a result of the anatomical findings, we would suggest a dorsal approach to the spinal cord, suprascapular nerve and sometimes to the axillary nerve, combined with an anterior exposure to the brachial plexus in order to have the whole plexus explored and routine simultaneous nerve transfers performed. In selected cases, with limited root injuries, the dorsal approach to the brachial plexus and spinal cord and the anterior approach to the brachial plexus and spinal cord might be of interest.

Brachial Plexus↗
PubMed1998

Effects of neurolysis during nerve regeneration: a behavioral and electrophysiologic study.

In closed injuries, nerves may be damaged by compression, stretch, or friction; the lesion may be circumscribed or extensive. Indications for exploratory surgery are very difficult to establish. However, in a number of cases, no lesions are observed during surgery and only neurolysis is performed. Neurolysis, nevertheless, may devascularize the nerves, compromising the final outcome of nerve regeneration. The goal of this reported work was to study the effects of neurolysis during the process of regeneration. Experiments were performed in the rat median nerve, and assessment was made by behavioral and electrophysiologic studies 2, 3, 6 and 12 weeks after surgery. The experiments demonstrated that exploratory microneurolysis had no deleterious effect on nerve recovery when performed during the process of nerve regeneration. Indeed, microneurolysis accelerated the rate of nerve recovery. Early exploratory surgery thus had no deleterious effects on nerve regeneration, and not only offered a better prognosis in reparable lesions, but also a potential beneficial effect of neurolysis in accelerating recovery.

Animals↗
PubMed1998

Selective restoration of sensation by peripheral nerve grafts directly implanted into the contralateral C7 dorsal root ganglion: an experimental study in rat brachial plexus.

OBJECTIVE: In brachial plexus injuries, when the dorsal root ganglion (DRG) is avulsed from the spinal cord there is no possibility of direct repair. Therefore, in the present report the median nerve was connected directly to the contralateral C7 DRG, to restore forepaw sensation. METHODS: The ulnar nerve was sectioned, and a 15-mm segment of nerve was removed. The median nerve was sectioned, transposed dorsally, and repaired using a sural nerve graft directly implanted into the C7 contralateral DRG. Rats were then assessed 6 and 12 months later by behavioral, histological, and plasma extravasion techniques. RESULTS: All animals recovered sensation in the forepaw. Retrogradely labeled sensory neurons were demonstrated in the C7 DRG, and the whole forepaw was labeled after plasma extravasion induction by median nerve antidromic stimulation. Several myelinated and positively neurofilament-stained fibers were demonstrated in the grafted median nerve. CONCLUSION: The surgical strategy proposed might be a useful alternative to selective sensory repair in the emerging field of brachial plexus reconstruction by direct spinal cord surgery.

Animals↗
PubMed1998

The neurocutaneous flap based on the dorsal branches of the ulnar artery and nerve: a new flap for extensive reconstruction of the hand.

Soft-tissue repair in the hand often requires skin flaps due to exposure of bone, tendons, nerves, and arteries. However, alternatives for flap surgery are very limited, especially in dealing with palmar hand reconstruction. In the present report, the dorsal branch of the ulnar nerve and its accompanying artery were studied anatomically, and a neurocutaneous flap distally based on these structures was developed. The flap was raised on the medial aspect of the hand and distal half of the forearm, and its rotation point was located dorsally near the metacarpalphalangeal joints. The clinical use of this flap for the repair of skin defects in the hand is reported. All the clinical flaps survived completely, including a 3.5 x 13-cm large flap. Donor site morbidity was minimal. This flap represents a new alternative in hand reconstruction.

Adolescent↗
PubMed1997

Neurocutaneous island flaps in upper limb coverage: experience with 44 clinical cases.

The vascularity of the cutaneous nerve of the upper limb is closely connected with the vascularity of the skin. Both skin and nerves are vascularized by perforators of the main arteries. Small longitudinal paraneural vessels, in close contact with the cutaneous nerves that they supply, link these perforating arteries. Based on these anatomic findings, 44 cutaneous flaps (so-called neurocutaneous flaps, supplied by the vessels around and inside the cutaneous nerves) were raised. The neurocutaneous flap provided reliable coverage of skin defects in the upper limb. The flap dimensions were as large as 4 x 10 cm. The proximally based flaps were extremely safe, as were the free flaps and the flaps based distally on the dorsal side of the hand. One flap distally based on the medial antebrachial cutaneous nerve of the forearm and three used in thumb reconstruction underwent necrosis. Neurocutaneous island flaps are easy to dissect, they are reliable and versatile, and major vessels like the radial, ulnar, and posterior interosseous arteries are preserved. In the majority of cases, the donor site may be closed primarily and donor site morbidity is minimal.

Adult↗
PubMed1997

The plantar marginal septum cutaneous island flap: a new flap in forefoot reconstruction.

Soft-tissue reconstruction of the foot very often requires flap coverage to preserve exposed structures such as bone, joint, tendons, and weight-bearing areas. However, forefoot coverage remains a challenge, since the alternatives for flap coverage are very limited. The vascularization of the medial side of the foot was studied in 25 injected limbs. Based on this anatomic knowledge, the plantar marginal septum cutaneous island flap is described. The plantar marginal septum cutaneous island flap is a reversed-flow flap based on the superficial branch of the medial division of the medial plantar artery and its distal anastomosis with the lateral plantar artery, first dorsal metatarsal artery, and lateral branch of the medial plantar artery. The venous drainage is ensured by the accompanying veins. The flap arc of rotation includes the forefoot plantar and dorsal region and the first and second toes. Eight cases have been operated on and are reported.

Adult↗
PubMed1997

Selective motor hyperreinnervation using motor rootlet transfer: an experimental study in rat brachial plexus.

Misdirection of sensory fibers into motor pathways is, in part, responsible for the poor results obtained after peripheral nerve repair. After avulsion of the C-5 root in rats, the authors connected a C-4 ventral rootlet to the musculocutaneous nerve by means of a sural nerve graft. In this way, they were able to increase the number of regenerating motor fibers and avoid growth of sensory fibers into the nerve grafts. Functional recovery was evaluated electrophysiologically and histologically. The origin of the axons that reinnervated the nerve graft was analyzed by means of morphological studies including retrograde labeling procedures. Motor neurons survived and regenerated after the rootlet transfer and there was no functional impairment. Many neurons were retrograde labeled in the ventral horn and widespread biceps muscle reinnervation was demonstrated with recovery of nearly normal electrophysiological properties. Motor hyperreinnervation of the musculocutaneous nerve was observed. This high degree of reinnervation in a long (40-mm) graft was attributed to the good chance that a muscle fiber can be reinnervated by a motor fiber when the number of regenerating motor neurons is increased and when competitive sensory fibers are excluded from reinnervation.

Animals↗