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PONENTES INVITADOS

A Gilbert (Francia) H Millesi (Austria) P Raimondi (Italia)

Es un honor y un placer para la Asociación Española de Microcirugía realizar este homenaje al Dr Santos Palazzi Coll con ocasión de su retiro de la actividad clínica. Líder y referente mundial durante décadas de la Microcirugía del Plexo Braquial y del Nervio Periférico, el Dr Palazzi ha tenido una exitosa, brillante carrera profesional además de una intensa actividad docente y científica.

Gracias, Dr Palazzi, por el trabajo, esfuerzo y dedicación de todos estos años. Gracias, Dr Palazzi, por haber sido una de las figuras claves en el desarrollo de la Microcirugía en España y de esta nuestra Asociación Española de Microcirugía.

Dr. JM Rodríguez Vegas Presidente de la AEM

para más información visite nuestra web

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A S O C I A C I Ó N E S PA Ñ O L A D E M I C R O C I R U G Í A

A S O C I A C I Ó N E S PA Ñ O L A D E M I C R O C I R U G Í A

Organizado por la

ASOCIACIÓN ESPAÑOLA DE

MICROCIRUGÍA

homenaje al dr santos palazzi coll

Ilustre Colegio Oficial de Medicos de Madrid

(SALA PEQUEÑO ANFITEATRO)

C/ Santa Isabel, 51 28012 Madrid

S Á B A D O , 1 3 D E D I C I E M B R E D E 2 0 1 4 S Á B A D O , 1 3 D E D I C I E M B R E D E 2 0 1 4 S Á B A D O , 1 3 D E D I C I E M B R E D E 2 0 1 4

A G E N D A

09,00 - 11.00 Asamblea General Ordinaria de la Asociación Española de Microcirugía

11,00 - 11,15Presentación de la Jornada Dr M Cuadros. Ex-Presidente de AEM Srta M. Sanz. Ex-Presidente de AEM Dr JM Rodríguez Vegas. Presidente de AEM

11,15 - 11,45Historia de la Cirugía de la Parálisis Braquial Obstétrica Dr A Gilbert

11,45 - 12,1540 años de cirugía del plexo braquial: mi experiencia paralela con Santos Palazzi Dr P Raimondi

12,15 - 13,00Tissue Dynamic and Peripheral Structure Dr H Millesi

13,00 - 13,30Entre amigos Dr M Cuadros

13,30 - 14,00 Palabras finales, abrazos y clausura

SÁBADO, 13 de DICIEMBRE de 2014 Ilustre Colegio Oficial de Médicos de Madrid. C/ Santa Isabel 51 MADRID Sala Pequeño Anfiteatro

DR SANTOS PALAZZI

NEUROTIZATION WITH THE BRACHIALIS MUSCLE MOTOR NERVE

SANTOS PALAZZI, M.D.,* JOSE-LUIS PALAZZI, M.D., and JUAN-PABLO CACERES, M.D.

Function of the wrist and hand in lower root avulsions is severely impaired. Based on anatomic and experimental studies which suggestthat the motor nerve of the brachialis muscle could be used as a selective neurotizator in lower root avulsions with intact C5–C6 6 C7roots (Klumpke paralysis), we considered its use depending on the target. We describe two techniques for the median nerve (in C8–T1avulsions) and one for the radial nerve (in C7–C8–T1 avulsions). In all cases, we added the lateral cutaneous nerve of the forearm in theneurotization to improve sensibility in the hand. The present report presents the results of its use in our first five patients.VVC 2006 Wiley-Liss, Inc. Microsurgery 26:330–333, 2006.

Avulsion of the C8–T1 root results in severe impairmentof both motor and sensitivity function of the wrist andhand. Commonly referred to as Klumpke paralysis, thistype of avulsion injury is characterized by paralysis of allfinger flexors, of the flexor pollicis longus, and of all the-nar and hypothenar intrinsic musculature. Frequently, theclinical picture is similar to that observed in some tetra-plegic hands or in cases of a combined high-level lesionof both the median and ulnar nerves.

If the C7 root is also avulsed, the functional conditionof the hand is even worse. The patient will also displayparalysis of the wrist extensors, and paralysis of normalthumb and finger extension.

Avulsion of the lower roots (C8–T1 6 C7) with intactupper roots (C5–C6 6 C7) occurs very seldom, ranging from2% in the series of Narakas1 and Oberlin2 to 10% in the seriesby Seddon.3 To date, management of this condition hasincluded mostly palliative surgery, including transfer of thewrist extensors to finger flexors, transfer of the brachioradialisto the flexor pollicis longus, and stabilization of the thumbusing the arthrodeses or tenodeses. The results of these pallia-tive procedures have not been very convincing when therewas an avulsion of the C7 root. Moreover, palliative surgerydoes not offer sensibility to the hand.

Based on anatomic and experimental observation, Accioliproposed the use of the motor nerve of the brachialis muscleas a selective neurotizator in lower root avulsions with intactC5–C6 6 C7 roots (Klumpke paralysis).4 The brachialismotor nerve receives its nerve fibers from the C5–C6 6 C7roots of the brachial plexus. It is the distal motor branch of themusculocutaneous nerve (Fig. 1). Normally, it is a singlenerve that runs distally to the biceps motor nerve, and whichterminates in the muscular substance of the brachialis muscle

with two or three rami (Fig. 2). The brachialis motor nervecarries about 2,090 (6462) motor axons, and has a diameterof about 1.8–2.4 mm. It functions as a pure elbow flexor.However, denervation of the brachialis does not impair elbowflexion, as only 10–20% of the total flexion strength at theelbow joint depends on the brachialis muscle.5

Based on the findings of Accioli,4 we considered threedifferent possibilities for using the brachialis motor nerveas a neurotizator. We describe two techniques for the me-dian nerve (in C8–T1 avulsions) and one for the radialnerve (in C7–C8–T1 avulsions). In all cases, we were ableto add the lateral cutaneous nerve of the forearm in theneurotization, in order to improve sensibility in the hand.This report presents our first results using the brachialismotor nerve as a neurotizator in five patients (Table 1).

METHODS

Technique A

This method is used for avulsion of the C8–T1 rootwith paralysis of the epitrochlear branch (EB) of the me-dian nerve. In these cases, direct neurorraphy without ten-sion of the brachialis motor nerve to the EB is per-formed. The aim in these cases is to reinervate the prona-tor teres and wrist flexors.

Technique B

The second technique is used for avulsion injuries ofthe C8–T1 roots of the brachial plexus, but with activefunction of the EB of the median nerve. In this situation,we performed end-to-side neurorraphy of the brachialismotor nerve below the exit of the active EB in the me-dian nerve trunk. In this situation, the procedure is aimedat reinervating the flexors of the fingers and the thumb.

Technique C

This third and last technical variation was applied topatients with avulsion of the C7–C8–T1 roots. In thesecases, priority should be given to the wrist and fingerextensors. Nerve grafts are used to connect the brachialis

Hand and Microsurgery Unit, Centro Medico Teknon, Barcelona, Spain

*Correspondence to: Santos Palazzi, M.D., Hand and Microsurgery Unit,Centro Medico Teknon, Vilana 12, 08022 Barcelona, Spain.E-mail: palazzi@sirt.es

Received 25 November 2005; Accepted 15 January 2006

Published online 9 May 2006 in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/micr.20247

VVC 2006 Wiley-Liss, Inc.

Microc i r ug ía de l P lexo Braqu ia l y de l Ner v io Per i fé r i co