medigraphic.com
ISSN 2992-8559 (Electronic)
ISSN 1405-0625 (Print)

2005, Number 2

<< Back Next >>

Cir Plast 2005; 15 (2)

Complete medullar section treated with intercostal nerve flap

Cuenca-Pardo J, Álvarez-Díaz CJ, Casas- Martínez G, Moreno-Vera C

Language: Spanish
References: 18
Page: 73-82
PDF size: 328.12 Kb.


ABSTRACT

Complete medullar section produces severe functional changes, with an inability to move that forces patients to remain in bed, favoring the formation of pressure sores, infection and malnutrition. Different procedures to repair the damage have been carried out, such as suture of the sectioned medulla; intersegmentary anastomoses of the nerve roots, or anastomoses of outlying nerve to the lumbar plexus, without satisfactory results. Turbes carried out studies in dogs with medullar section, in which anastomoses of outlying intercostal nerve was made in the medulla in the immediate distal part closest to the section, obtaining results in mobility and axonal regeneration. We carried out a controlled study in eight patients with complete medullar section; in Group I, with four patients that were not operated on, spontaneous recovery went from one to two levels below the lesion, and in Group II, with four patients, intercostal nerve flap was implanted to the portion immediately below to the lesion, with electrostimulation, recovering sensibility from 6 to 9 dermatomes; the function of the abdomen, hip, thigh and leg muscles. Three patients were able to have an acceptable control to urinate and defecate, and one of them was able to have erections and sustain sexual intercourse. The procedure in patients with complete medullar section has enabled recovery of up to 9 levels of sensitivity to the lesion site, recovery of function in some muscles and in some of them, neurovegetative functions; therefore this procedure is very useful in patients that suffer medullar section.


REFERENCES

  1. Guttman L. Lesiones medulares, tratamiento global e investigación. Barcelona: JIMS Tomo I, II, III; 1981: 3-683.

  2. Satir V. Relaciones humanas en el núcleo familiar. México: Ed Pax 1986: 123-272.

  3. Kubler RE. Etapas de duelo. En: Kubler RE. Libro La Muerte y los Moribundos. México: Ed. Grijalbo 1999: 2-76.

  4. Alexander RH, Proctor HJ. Traumatismo raquimedular. En: Colegio Americano de Cirujanos: Curso avanzado de apoyo vital en trauma para médicos. 5a Ed., 1992: 213-233.

  5. Junqueira LC, Carneiro J. Tejido nervioso. En: Histología Básica. Ed. Salvat. 1978: 140-188.

  6. Quiroz GF, Sistema nervioso central, médula espinal, plexo lumbar. México: Porrúa S.A. 1994: 206-519.

  7. Margel F, Aebi M. A Comprehensive classification of thoracic and lumbar injuries. AO ASIF principles in spine surgery. 1999: 20-41.

  8. Lumashev GS, Rumiantseviu V, Aganesov AG. Anastomoses of intercostal nerves with the roots of the cauda equina in the late stage of complicated trauma of the lower thoracic and lumbar spine. Ortop Travmatol Protez 1988; 11: 39-43.

  9. Dai KR, Yu CT, Wu RS, Zhang XF, Yuan JX, Sun YH. Intercostal lumbar spinal nerve anastomoses for cord transection. A preliminary investigation. Reconstr Microsurg 1985; 1(3): 223-6.

  10. Moriishi J, Otani K, Inoe S. The intersegmental anastomoses between spinal nerve roots. Anastomoses. Anat Rec 1989; 224(1): 110-6.

  11. Seddon HJ, Medaward PB, Smith H. Rate of regeneration of peripheral nerves in man. J Physiol 1943; 102: 191-215.

  12. Brunelli G. Direct neurotization of severely damaged muscles. J Hand Surg 1982; 6: 572-79.

  13. Sakellarides HT, Sorbie CH, James L. Reinervation of denervated muscles by nerve transplantation. Clin Orthop and Relat Res 1972; 83: 194-201.

  14. O´Brien BM. Principles and techniques of microvascular surgery. In: McCarthy J. Plastic Surgery, Vol 1: General Principles. Philadelphia: WB Saunders 1990: 412-74.

  15. Tomita Y, Tsai T M, Burns JT, Karaoguz A. Ogden LL. Intercostal nerve transferring brachial plexus injuries: An experimental study. Microsurgery 1983; 4(2): 95-104.

  16. Turbes CC. Peripheral nerve (PNS) spinal cord anastomoses brinding spinal cord transection-enhancement of central neurons (CNS) axonal regeneration. biomed. Sci Instrum 1997; 33: 326-31.

  17. Turbes CC. Intercostal nerve neuroma (PNS) implantation in spinal cord anastomosis bridging spinal cord transection-enhancement of central neurons (CNS) axonal regeneration. Biomed Sci Instrum 1997; 34: 344-50.

  18. Turbes CC. Repair, reconstruction, regeneration and rehabilitation strategies to spinal cord injury. Biomed Sci Instrum 1997; 34: 351-6.




2020     |     www.medigraphic.com