Free functional gracilis transfer for reconstruction of isolated anterior deltoid atrophy following surgical proximal humerus fixation
Palsy of the clavicular head of the deltoid is a complication after surgical fixation of proximal humerus fractures. Flexion of the shoulder joint may be impaired as a result. Additionally, patients may complain of joint instability, visible atrophy, and pain. Where nerve reconstruction is not possi...
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Veröffentlicht in: | Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2024-12, Vol.99, p.160-167 |
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container_title | Journal of plastic, reconstructive & aesthetic surgery |
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creator | Gstoettner, C. Laengle, G. Boesendorfer, A. Sturma, A. Politikou, O. Salminger, S. Aszmann, O.C. |
description | Palsy of the clavicular head of the deltoid is a complication after surgical fixation of proximal humerus fractures. Flexion of the shoulder joint may be impaired as a result. Additionally, patients may complain of joint instability, visible atrophy, and pain. Where nerve reconstruction is not possible, muscle transfers remain as secondary reconstructive procedures.
Three patients with anterior deltoid palsy after proximal humerus fixation received a free functional gracilis transfer to the shoulder. Postoperatively, patients underwent biofeedback-based rehabilitation. Before and after the intervention, subjective complaints, pain level, and active range of motion (ROM) were recorded. At the final follow-up, patients completed a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
The surgery was successful in all patients, with first muscle signals registered through surface electromyography approximately four months postoperatively. At the last follow-up (>3 years), the patients showed improved shoulder stability and pain scores. In two patients with preoperative restrictions, active ROM improved. The DASH score showed minimal to no disability in two patients and moderate disability in the third. Two patients voiced satisfaction with the restoration of the ventral bulk of the shoulder.
Free functional gracilis muscle transfer is a novel approach for secondary reconstruction in patients with anterior deltoid atrophy who do not qualify for nerve intervention. It addresses shoulder instability and pain and may improve active ROM. The addition of fresh muscle tissue to the ventral shoulder can improve its natural contour and prevent protrusion of the humeral head. |
doi_str_mv | 10.1016/j.bjps.2024.09.003 |
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Three patients with anterior deltoid palsy after proximal humerus fixation received a free functional gracilis transfer to the shoulder. Postoperatively, patients underwent biofeedback-based rehabilitation. Before and after the intervention, subjective complaints, pain level, and active range of motion (ROM) were recorded. At the final follow-up, patients completed a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
The surgery was successful in all patients, with first muscle signals registered through surface electromyography approximately four months postoperatively. At the last follow-up (>3 years), the patients showed improved shoulder stability and pain scores. In two patients with preoperative restrictions, active ROM improved. The DASH score showed minimal to no disability in two patients and moderate disability in the third. Two patients voiced satisfaction with the restoration of the ventral bulk of the shoulder.
Free functional gracilis muscle transfer is a novel approach for secondary reconstruction in patients with anterior deltoid atrophy who do not qualify for nerve intervention. It addresses shoulder instability and pain and may improve active ROM. The addition of fresh muscle tissue to the ventral shoulder can improve its natural contour and prevent protrusion of the humeral head.</description><identifier>ISSN: 1748-6815</identifier><identifier>ISSN: 1878-0539</identifier><identifier>EISSN: 1878-0539</identifier><identifier>DOI: 10.1016/j.bjps.2024.09.003</identifier><identifier>PMID: 39378555</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adult ; Aged ; Axillary nerve lesion ; Deltoid Muscle - surgery ; Deltoid palsy ; Electromyography ; Female ; Fracture Fixation, Internal - methods ; Free functional muscle transfer ; Gracilis Muscle - transplantation ; Gracilis muscle flap ; Humans ; Male ; Middle Aged ; Muscular Atrophy - etiology ; Plastic Surgery Procedures - methods ; Postoperative Complications - surgery ; Proximal humerus fracture ; Range of Motion, Articular ; Shoulder Fractures - surgery</subject><ispartof>Journal of plastic, reconstructive & aesthetic surgery, 2024-12, Vol.99, p.160-167</ispartof><rights>2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons</rights><rights>Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c237t-7bfe05324e380ee8e384f06a6ffecafdf698d063a38001ce97b981c393daf1a83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.bjps.2024.09.003$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>315,781,785,3551,27928,27929,45999</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39378555$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gstoettner, C.</creatorcontrib><creatorcontrib>Laengle, G.</creatorcontrib><creatorcontrib>Boesendorfer, A.</creatorcontrib><creatorcontrib>Sturma, A.</creatorcontrib><creatorcontrib>Politikou, O.</creatorcontrib><creatorcontrib>Salminger, S.</creatorcontrib><creatorcontrib>Aszmann, O.C.</creatorcontrib><title>Free functional gracilis transfer for reconstruction of isolated anterior deltoid atrophy following surgical proximal humerus fixation</title><title>Journal of plastic, reconstructive & aesthetic surgery</title><addtitle>J Plast Reconstr Aesthet Surg</addtitle><description>Palsy of the clavicular head of the deltoid is a complication after surgical fixation of proximal humerus fractures. Flexion of the shoulder joint may be impaired as a result. Additionally, patients may complain of joint instability, visible atrophy, and pain. Where nerve reconstruction is not possible, muscle transfers remain as secondary reconstructive procedures.
Three patients with anterior deltoid palsy after proximal humerus fixation received a free functional gracilis transfer to the shoulder. Postoperatively, patients underwent biofeedback-based rehabilitation. Before and after the intervention, subjective complaints, pain level, and active range of motion (ROM) were recorded. At the final follow-up, patients completed a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
The surgery was successful in all patients, with first muscle signals registered through surface electromyography approximately four months postoperatively. At the last follow-up (>3 years), the patients showed improved shoulder stability and pain scores. In two patients with preoperative restrictions, active ROM improved. The DASH score showed minimal to no disability in two patients and moderate disability in the third. Two patients voiced satisfaction with the restoration of the ventral bulk of the shoulder.
Free functional gracilis muscle transfer is a novel approach for secondary reconstruction in patients with anterior deltoid atrophy who do not qualify for nerve intervention. It addresses shoulder instability and pain and may improve active ROM. The addition of fresh muscle tissue to the ventral shoulder can improve its natural contour and prevent protrusion of the humeral head.</description><subject>Adult</subject><subject>Aged</subject><subject>Axillary nerve lesion</subject><subject>Deltoid Muscle - surgery</subject><subject>Deltoid palsy</subject><subject>Electromyography</subject><subject>Female</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Free functional muscle transfer</subject><subject>Gracilis Muscle - transplantation</subject><subject>Gracilis muscle flap</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Muscular Atrophy - etiology</subject><subject>Plastic Surgery Procedures - methods</subject><subject>Postoperative Complications - surgery</subject><subject>Proximal humerus fracture</subject><subject>Range of Motion, Articular</subject><subject>Shoulder Fractures - surgery</subject><issn>1748-6815</issn><issn>1878-0539</issn><issn>1878-0539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1uFDEQhC0URP54AQ7Ix1xmsMfz45G4oCghSJG4kLPl9bQ3XnnHS9sDyQvw3PSwgSOnbtlflbqKsXdS1FLI_sOu3uwOuW5E09ZirIVQr9iZ1IOuRKfGE9qHVle9lt0pO895J0SrZNu9YadqVIPuuu6M_bpFAO6X2ZWQZhv5Fq0LMWRe0M7ZA3KfkCO4NOeCyx-MJ89DTtEWmLidC2AgZoJYUqCHgunw-Ey6GNPPMG95XnAbHJkfMD2FPS2Pyx5wydyHJ7s6XrLX3sYMb1_mBXu4vfl2fVfdf_385frTfeUaNZRq2HigbE0LSgsATaP1ore99-Csn3w_6kn0ytK3kA7GYTNq6SjuZL20Wl2wq6MvXfJ9gVzMPmQHMdoZ0pKNkrJtR92LFW2OqMOUM4I3B6Tb8dlIYdb-zc6s_Zu1fyNGQ_2T6P2L_7LZw_RP8rdwAj4eAaCUPwKgyS7A7GAK1HExUwr_8_8NNFebzg</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Gstoettner, C.</creator><creator>Laengle, G.</creator><creator>Boesendorfer, A.</creator><creator>Sturma, A.</creator><creator>Politikou, O.</creator><creator>Salminger, S.</creator><creator>Aszmann, O.C.</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202412</creationdate><title>Free functional gracilis transfer for reconstruction of isolated anterior deltoid atrophy following surgical proximal humerus fixation</title><author>Gstoettner, C. ; Laengle, G. ; Boesendorfer, A. ; Sturma, A. ; Politikou, O. ; Salminger, S. ; Aszmann, O.C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c237t-7bfe05324e380ee8e384f06a6ffecafdf698d063a38001ce97b981c393daf1a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Axillary nerve lesion</topic><topic>Deltoid Muscle - surgery</topic><topic>Deltoid palsy</topic><topic>Electromyography</topic><topic>Female</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Free functional muscle transfer</topic><topic>Gracilis Muscle - transplantation</topic><topic>Gracilis muscle flap</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Muscular Atrophy - etiology</topic><topic>Plastic Surgery Procedures - methods</topic><topic>Postoperative Complications - surgery</topic><topic>Proximal humerus fracture</topic><topic>Range of Motion, Articular</topic><topic>Shoulder Fractures - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gstoettner, C.</creatorcontrib><creatorcontrib>Laengle, G.</creatorcontrib><creatorcontrib>Boesendorfer, A.</creatorcontrib><creatorcontrib>Sturma, A.</creatorcontrib><creatorcontrib>Politikou, O.</creatorcontrib><creatorcontrib>Salminger, S.</creatorcontrib><creatorcontrib>Aszmann, O.C.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gstoettner, C.</au><au>Laengle, G.</au><au>Boesendorfer, A.</au><au>Sturma, A.</au><au>Politikou, O.</au><au>Salminger, S.</au><au>Aszmann, O.C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Free functional gracilis transfer for reconstruction of isolated anterior deltoid atrophy following surgical proximal humerus fixation</atitle><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle><addtitle>J Plast Reconstr Aesthet Surg</addtitle><date>2024-12</date><risdate>2024</risdate><volume>99</volume><spage>160</spage><epage>167</epage><pages>160-167</pages><issn>1748-6815</issn><issn>1878-0539</issn><eissn>1878-0539</eissn><abstract>Palsy of the clavicular head of the deltoid is a complication after surgical fixation of proximal humerus fractures. Flexion of the shoulder joint may be impaired as a result. Additionally, patients may complain of joint instability, visible atrophy, and pain. Where nerve reconstruction is not possible, muscle transfers remain as secondary reconstructive procedures.
Three patients with anterior deltoid palsy after proximal humerus fixation received a free functional gracilis transfer to the shoulder. Postoperatively, patients underwent biofeedback-based rehabilitation. Before and after the intervention, subjective complaints, pain level, and active range of motion (ROM) were recorded. At the final follow-up, patients completed a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
The surgery was successful in all patients, with first muscle signals registered through surface electromyography approximately four months postoperatively. At the last follow-up (>3 years), the patients showed improved shoulder stability and pain scores. In two patients with preoperative restrictions, active ROM improved. The DASH score showed minimal to no disability in two patients and moderate disability in the third. Two patients voiced satisfaction with the restoration of the ventral bulk of the shoulder.
Free functional gracilis muscle transfer is a novel approach for secondary reconstruction in patients with anterior deltoid atrophy who do not qualify for nerve intervention. It addresses shoulder instability and pain and may improve active ROM. The addition of fresh muscle tissue to the ventral shoulder can improve its natural contour and prevent protrusion of the humeral head.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>39378555</pmid><doi>10.1016/j.bjps.2024.09.003</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Aged Axillary nerve lesion Deltoid Muscle - surgery Deltoid palsy Electromyography Female Fracture Fixation, Internal - methods Free functional muscle transfer Gracilis Muscle - transplantation Gracilis muscle flap Humans Male Middle Aged Muscular Atrophy - etiology Plastic Surgery Procedures - methods Postoperative Complications - surgery Proximal humerus fracture Range of Motion, Articular Shoulder Fractures - surgery |
title | Free functional gracilis transfer for reconstruction of isolated anterior deltoid atrophy following surgical proximal humerus fixation |
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