Transection of the radial nerve is frequently associated with humeral shaft fractures that are part of a very complex upper extremity injury. In the presented case, a 19-year-old man with a 10-cm radial nerve defect with a need for nerve grafting to recover complete sensory and motor deficit of the radial nerve. In our case, at the same time we provided the tendon transfer of musculus (m.) pronator teres to m. extensor carpi radialis brevis, m. flexor carpi ulnaris to m. extensor digitorum communis, m. palmaris longus to m. extensor pollicis longus, and long sural nerve graft because of an extensive zone of the injury. The assumption was that if these two procedures are performed in one surgery, it will accelerate overall recovery, restore the functionality of the upper limb more quickly, and thus enable a faster recovery.

• MeSH
• autologní transplantace metody   MeSH
• fraktury humeru chirurgie   terapie   MeSH
• horní končetina chirurgie   diagnostické zobrazování   patologie   zranění   MeSH
• kosterní svaly chirurgie   transplantace   MeSH
• lidé MeSH
• mladý dospělý MeSH
• nervus radialis * chirurgie   patologie   transplantace   MeSH
• nervus suralis chirurgie   transplantace   MeSH
• neurochirurgické výkony metody   MeSH
• přenos šlachy metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

The authors present an anatomical study and clinical experience with radial forearm flap (RFF) and pronator quadratus muscle (PQM) application in the reconstruction of various body areas. The aim was to describe the anatomical placement and proportions of the PQM, the anatomical location of the major arterial branch of the radial artery supplying the PQM, and the application of this knowledge in clinical practice. The anatomical study was based upon an analysis of 13 fresh adult cadaver upper extremities, of which nine were female and four male; both arms from the same donors were used in four cases. The study of the PQM was performed using a dye-containing intraarterial injection, standard macro- and micro-preparation techniques, and chemical digestion. The data on the PQM size in males and females, thickness of the radial artery branch (the principal artery nourishing the muscle), and its position were analysed. The radial artery branch nourishing the PQM was identified in all cadaveric specimens of the anatomical study. In addition, 12 patients underwent reconstructions of soft and bony tissue defects using a RFF + PQM (pedicled or free flap). The radial artery branch perfusing the PQM was identified in all cases. The flap was used for the management of defects of the head (seven cases), arm (three cases) and lower leg (two cases). The harvest site healed well in all cases and, with the exception of one case in which a partial necrosis of the flap was observed, all flaps remained viable, which demonstrated the safety of the method.

• MeSH
• arteria radialis chirurgie   MeSH
• dospělí MeSH
• kosterní svaly transplantace   MeSH
• lidé MeSH
• předloktí chirurgie   krevní zásobení   MeSH
• volné tkáňové laloky * chirurgie   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• předloketní lalok, anterolateral thigh flap,
• MeSH
• chirurgické laloky * klasifikace   transplantace   MeSH
• kosterní svaly anatomie a histologie   transplantace   MeSH
• lidé MeSH
• musculus gracilis transplantace   MeSH
• myokutánní lalok klasifikace   transplantace   MeSH
• povrchové zádové svaly anatomie a histologie   transplantace   MeSH
• stehno anatomie a histologie   krevní zásobení   MeSH
• zádové svalstvo anatomie a histologie   transplantace   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.

• MeSH
• acetabulum zranění   MeSH
• činnosti denního života MeSH
• dospělí MeSH
• fraktury kostí komplikace   MeSH
• kosterní svaly inervace   transplantace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mononeuropatie etiologie   chirurgie   MeSH
• pánevní kosti zranění   MeSH
• paraplegie etiologie   chirurgie   MeSH
• plexus lumbosacralis zranění   MeSH
• poranění dolní končetiny chirurgie   MeSH
• poranění periferního nervu etiologie   chirurgie   MeSH
• přenos šlachy metody   MeSH
• prognóza MeSH
• senioři MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Transposition of tibialis posterior muscle ranks among the methods of dorsiflexion restoration in patients with peroneal nerve palsy. Even though this method is commonly used, anatomical variations are still encountered which make us modify the established procedures. The purpose of this study is to evaluate the functional outcomes of operated patients and based on the clinical experience to define by cadaver preparation the anatomical causes preventing the use of the standard transposition technique. MATERIAL AND METHODS The clinical group includes 21 patients (15 men, 6 women) with the mean age of 34.2 years and with common peroneal nerve palsy confirmed by EMG. In 20 patients, transposition of the tendon of the tibialis posterior muscle (MTP) through the interosseous membrane of the leg was performed. In one patient the tendon was transposed ventrally to the distal end of the tibia and fixed in the lateral cuneiform bone due to an extremely narrow space of the interosseous membrane of the leg distally between the lower limb bones. In 18 patients the tendon was fixed by osteosuture to the base of 3rd metatarsal bone, in three patients to the lateral cuneiform bone. The outcomes were evaluated at 6 months after the surgery, when active ankle dorsiflexion (DF) range of motion greater than 5° was considered an excellent outcome, active position at 90° up to DF less than 5° a satisfactory outcome, and any plantigrade position as a poor outcome. The anatomical study included 20 extremities fixed by formalin (10 cadavers, 5 men and 5 women with the mean age of 71.3 years). The length of the individual parts of tibialis posterior muscle was measured and the variations of the muscle attachment were evaluated. The measurement was concluded by a simulation of surgical procedure. RESULTS When evaluating the clinical group, an excellent outcome was reported in 12 patients (57%), a satisfactory outcome in 8 patients (38%) and a poor outcome in one patient (5%). When evaluating the anatomical group, a division of the attaching part of the tendon into three main strips was observed. The thickest middle strip attached to the tuberosity of navicular bone and medial cuneiform bone was reported in all the specimens. The thinner lateral strip (originating from the tendon in 90% of specimens) was attached to the intermediate and lateral cuneiform bone, the cuboid bone, metatarsal bones II-V, and moreover it grows into the origin of the flexor hallucis brevis muscle. The third strip of the tendon attached to the sustentaculum tali, plantar calcaneonavicular ligament and fibrocartilago navicularis was missing in one specimen (5%). When the passing the tendon through the interosseous space between the lower limb bones was simulated in order for the tendon to go in the direction of the planned traction, in two specimens (10%) the pulling through was impossible due to the tendon being thicker than the interosseous space. In two specimens (10%) it was not the tendon, but already the muscular belly which passed through the given space. DISCUSSION In our group, 95% of the functional outcomes were excellent or satisfactory. A poor result was reported in one patient, in whom the EMG examination was not performed as a standard procedure and in whom the muscular strength was insufficient to achieve full dorsiflexion of the ankle. The anatomical study indicates that the narrow space between the lower limb bones can prevent the pulling through of the tendon, which can be addressed intraoperatively by the transposition of the tendon ventrally to tibia. The study reveals that the tendon necessary for transposition can be elongated by the strips of the tendon attached to the sole of the foot. CONCLUSIONS The knowledge of the anatomical conditions may help us better manage potential complications intraoperatively. Key words: tibialis posterior muscle, peroneal nerve palsy, transposition of tibialis posterior muscle, anatomy of tibialis posterior muscle, common fibular nerve palsy.

• MeSH
• dospělí MeSH
• kosterní svaly transplantace   MeSH
• lidé MeSH
• mrtvola MeSH
• neuropatie nervus peroneus chirurgie   MeSH
• obnova funkce MeSH
• přenos šlachy metody   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Otvorené zlomeniny predkolenia so závažným postihnutím mäkkých tkanív a rozsiahlym kostným defektom sú naďalej vážnym terapeutickým problémom. Význam postihnutia mäkkých častí je často v klinickej praxi podceňovaný. V práci na kazuistike prezentujeme možnosti využitie masívnej heterológnej spongioplastiky v kombinácii s autológnymi osteoblastami ako alternatívu ku kalotaxii a prenosu vaskularizovaného kostného laloka. Kľúčové slová: bilaterálne otvorené tibiálne zlomeniny − kritický kostný defekt − svalové rotačné laloky − m.gastrocnemius − vákuum asistovaná terapia

Open tibial fractures with extensive soft tissue injury and accompanying bone defect are still a challenge for surgeons. Soft tissue injury is often underestimated in clinical practice. In our case report, we present the options for clinical usage of heterologous bone grafting combined with autologous bone stem cells as a therapeutic alternative to calotaxis and free bone flaps. Key words: bilateral open tibial fractures − critical size bone defects − local rotational muscle flaps − the gastrocnemius muscle – vacuum-assisted closure

• MeSH
• antibiotická profylaxe MeSH
• chirurgie operační metody   MeSH
• debridement MeSH
• dopravní nehody MeSH
• externí fixátory využití   MeSH
• fraktury tibie * diagnóza   chirurgie   patofyziologie   terapie   MeSH
• hojení fraktur MeSH
• homologní transplantace MeSH
• kosterní svaly transplantace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• osteoblasty MeSH
• otevřené fraktury * diagnóza   chirurgie   patofyziologie   terapie   MeSH
• poranění měkkých tkání etiologie   terapie   MeSH
• rentgendiagnostika MeSH
• transplantace heterologní MeSH
• transplantace kostí metody   MeSH
• transplantace mezenchymálních kmenových buněk využití   MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

We studied the effect of regeneration, altered innervation and thyroid hormone (TH) levels on fiber type transitions in slow soleus (SOL) muscles grafted (GRAFT) into host extensor digitorum longus (EDLh) muscles of euthyroid (EU), hyperthyroid (HT) and hypothyroid (HY) Lewis strain rats. SOL muscles were excised from 3-week to 4-week-old inbred Lewis rats and intramuscularly transplanted into EDLh muscles of 2-month-old female rats of the same strain. The proportions of type 1, 2A, 2X and 2B fibers of GRAFT were determined by immunohistochemistry and compared with those of EDLh muscle and EDL and SOL muscles of the unoperated contralateral hind limb. After an average regeneration period of 6-7 months and after being reinnervated by the "fast" peroneal nerve of EDLh muscle, GRAFT was transformed into a fast muscle. However, the extent of GRAFT transformation varied with different TH states. In the EU rats, GRAFT contained about 95 % of fast fibers, among which type 2X and 2B fibers predominated (about 75 %). The transition toward fast muscle phenotype was more pronounced in HT status, where the fastest type 2B fibers predominated. On the contrary, in HY status, the slow to fast transformation was less pronounced, as GRAFT contained less type 2B and 2X but more type 2A and 1 fibers. We conclude that the type of innervation is the crucial factor for the slow to fast fiber type transitions in GRAFT, but the extent of muscle transformation is further modulated by altered TH status.

• MeSH
• časové faktory MeSH
• hormony štítné žlázy chemie   metabolismus   MeSH
• kosterní svaly cytologie   metabolismus   transplantace   MeSH
• krysa rodu rattus MeSH
• potkani inbrední LEW MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: Latissimus dorsi and teres major transfers to the lateral side of the humerus with lengthening of the pectoralis major and subscapularis muscles for residual shoulder deformity were compared in children and skeletally mature patients. METHODS: Fifteen patients (nine children, six skeletally mature patients aged three to 30 years, follow-up one to 22 years) were treated for internal shoulder contracture after birth plexus lesions: C5-C6 (seven patients); C5-7 (five patients); C5-C8-T1 (three patients, respectively). Range of movement, Mallet shoulder function score and radiographs were assessed. RESULTS: Pre-operatively, shoulder function restrictions were comparable in all patients. Postoperatively, external rotation, abduction and Mallet function score improved significantly (p < 0.05) in all patients except one. There were no differences in improvement between children and skeletally mature patients (p = 0.24-1.0). CONCLUSIONS: This technique improves external rotation and abduction of the shoulder for daily living activities in children and young, skeletally mature, patients.

• MeSH
• dítě MeSH
• dospělí MeSH
• kosterní svaly transplantace   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• neuropatie brachiálního plexu patofyziologie   chirurgie   MeSH
• předškolní dítě MeSH
• rotace MeSH
• rozsah kloubních pohybů MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

There will be evaluated more types of tendon anchoring in skeleton in the experiment, with the aim of choosing a type of tendoosseous connexus which is able to resist early active motion and muscular spasms in tetraplegic patients. There will be monitored objective parameters in the prospective clinical study: muscular strength and range of motion after the transfer. Subjective parameters: improvement evaluation of activities of daily living (ADL).

V experimentu bude biomechanicky vyhodnoceno více typů kotvení šlachy do skeletu z hlediska pevnosti v tahu s cílem zvolit typ tendooseálního spoje, který je schopen odolávat aktivnímu časnému pohybu a svalovým spazmům tetraplegických pacientů. V prospektivní klinické studii budou sledovány objektivní parametry: svalová síla a rozsah pohybu po transferu déltového svalu přes šlachový interposit na olekránon ulny k dosažení aktivní extenze lokte. Ve studii budou hodnoceny i subjektivní parametry: zhodnocení spektra aktivit denního života (ADL) po transferu.

• MeSH
• kosterní svaly transplantace   MeSH
• kvadruplegie MeSH
• kvalita života MeSH
• loket MeSH
• rozsah kloubních pohybů MeSH
• tenotomie MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

The gracilis myocutaneous flap has limited functional donor site morbidity and effectively contours genitoperineal reconstructions. When harvested using a traditional vertical skin paddle, distal-tip necrosis (secondary to inconsistent perforator anatomy) is a well-documented complication. Orienting the skin paddle transversely provides a reliable alternative with a shorter rotational arc but results in a more conspicuous deformity and smaller skin paddle when primary closure is desired. On the basis of recent anatomic studies, we designed a pedicled gracilis myocutaneous flap with a bilobed cutaneous paddle to maximally incorporate both the transverse and longitudinal dimensions of the flap's nearly circular angiosome. The bilobed design allows harvest of a larger transverse skin flap (with a shorter arc of rotation) while a shorter, more dependable vertical skin flap is inset into the transverse flap donor site (rather than inside the critical wound bed). Herein, we detail our surgical technique and provide 2 illustrative case examples.

• MeSH
• chirurgické laloky * MeSH
• kosterní svaly transplantace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• perineum chirurgie   MeSH
• senioři MeSH
• stehno MeSH
• transplantace kůže metody   MeSH
• vagina chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH