Sahakyan A. B., Yagdjyan G. V.
Centre of Plastic and Reconstructive Surgery & Microsurgery,
Yerevan, Armenia
Despite of last achievements in reconstractive surgery of peripheral nerves, the treat-ment of chro--nic da-mages of brachial plexus remains one of the complicated and disputable prob-lems in mo-dern restoring surgery. The amount of patients with labour damages in the residual period as well as the pa-tients with posttraumatic damages of brachial plexus was recently increased. Absence both of the ge--neral tac-tics of treatment of adduction contracture and operations on rehabilitation of brachium lead ha--ve pre-determined our interest to the given problem. The purpose of suggested method is the simultaneuos re--sto-ring of brachium lead in humeral articulation in patients with a paralysis of the C5-C6 brachial ple-xus.The peculiarities of innervation of musculus trapezius (MT) from cervical plexus by a spinal addi-ti-o-nal nerve (AN) make possible to use MT in damages of brachial plexus as active muscular transplant, and blood supply of a muscle from autonomous vascular area of transverse cervical artery (TCA) allow to cut out the muscular transplant from horizontal, clavicular part. The taking away of flap during this ope-ra-tion differs from a traditional method: in this case to provide essential length of transplantat is ne-ces-sa-ry to make the maximum mobilization of clavicular part of MT. The mobilization of transplantat is ma-de un-der optical magnification with the precision sceletization of TCA and AN in contain of muscular trans-plant. Length of flap, cut out in such a manner, is sufficient for a possibility of fastening both to "punktum mobile", and to "punktum fixum" of musculus deltoideus.In CPRS&MS in period from 1998 till 1999 were operated 4 patients aged from 12 to 34 years. The full interruption of C5-C6 fascicles was diagnosed clinically and electromyographically in all patients. Vo-lume of active lead in all patients was less than 900. In postoperation period the immobilization of an extremity in an abduction splint is made in a position 1100 about two weeks and 1000 within 3 weeks. Elec-tri-cal stimulation of the displaced muscle and AN was made according to the technique previously de-ve-lo-ped by physiatrists.Restoring of the active lead of extremity up to M3-M4 and increase of the lead volume more than 900 were registered in all patients in terms till 1 year after operation.
Thus, the suggested method of use of flap from MT from ipsilateral side can provide the restoring of abduction in patients with chronic upper paralyses (C5-C6).