Page 358 - Read Online
P. 358
outcome following transfer of the trapezius muscle varies provide satisfactory function and stability with fewer
considerably. complications.
The current technique of using the upper descending Declaration of patient consent
fibers is easy, quick and reliable with reproducible results The authors certify that they have obtained all appropriate
and a definite increase in shoulder stability and function. patient consent forms. In the form the patient(s) has/have
The mean level of abduction of 85° and flexion of 55.2° given his/her/their consent for his/her/their images and
achieved was encouraging. In 3 of 32 patients, almost other clinical information to be reported in the journal.
140° of abduction was obtained. In addition, patients were The patients understand that their names and initials will
satisfied with fullness in the otherwise atrophic deltoid not be published and due efforts will be made to conceal
region, improved forward flexion, a more stable shoulder their identity, but anonymity cannot be guaranteed.
joint, and decreased heaviness of the upper limb.
Financial support and sponsorship
Passive shoulder abduction of more than 90° and strong Nil.
adductors are important prerequisites, and an intensive
physiotherapy program should be initiated prior to transfer in Conflicts of interest
order to gain more passive abduction. If adequate abduction There are no conflicts of interest.
is not attained, shoulder arthrodesis is the last resort.
REFERENCES
Scar tissue secondary to prior surgery renders the
dissection challenging. The use of pillow under the 1. Terzis JK, Barmpitsioti A. Secondary shoulder reconstruction in patients
shoulder is recommended to elevate the field of with brachial plexus injuries. J Plast Reconstr Aesthet Surg 2011;64:843‑53.
dissection. The pillow should be removed prior to fixation 2. Chwei‑Chin Chuang D. Functioning free muscle transplantation for brachial
on the humerus lest the transfer be impossible and the 3. plexus injury. Clin Orthop Relat Res 1995;314:104‑11.
Elhassan B, Bishop A, Shin A, Spinner R. Shoulder tendon transfer options for
incision sutured under tension. adult patients with brachial plexus injury. J Hand Surg Am 2010;35:1211‑9.
Many patients have osteoporosis of the humerus secondary 4. Bateman JE. The Shoulder and Environs. St. Louis: CV Mosby; 1955.
Saha AK. Surgery of the paralyzed and flail shoulder. Acta Orthop Scand
5.
to disuse following injury to the brachial plexus, creating 1967;Suppl 97:5‑90.
difficulty in fixation of the clavicle to the humerus. 6. Haas SL. Treatment of permanent paralysis of deltoid muscle. JAMA
Adequate preparation of the undersurface of the clavicle 1935;104:99‑103.
and anterolateral surface of the humerus is very important, 7. Mayer L. Transplantation of the trapezius for paralysis of the abductors of
and washers with screws were used in the current study to 8. the arm. J Bone Joint Surg 1927;9:412‑20.
Berger A, Brenner PD. Secondary surgery following brachial plexus injuries.
overcome this problem. Serial radiographs at intervals have Microsurgery 1995;16:43‑7.
been discussed previously. Nonunion was not observed in 9. Cofield RH, Briggs BT. Glenohumeral arthrodesis: operative and long‑term
any cases, although one screw required removal. functional results. J Bone Joint Surg Am 1979;61:668‑77.
10. Severo AL, Maia PE, Lemos MB, Piluski PC, Lech OL, Fukushima WY. Transfer
Postoperative function depends on the greatest possible of the trapezius to the deltoid for the treatment of shoulder instability after
tension in the transferred muscle. Proximal mobilization lesions of the brachial plexus. Surg Sci 2013;4:459‑63.
of the trapezius muscle is limited secondary to possible 11. Karev A. Trapezius transfer for paralysis of the deltoid. J Hand Surg (Br)
1986;11:81‑3.
damage to the accessory nerve, which should be identified 12. Singh AK, Karki D. Modified trapezius transfer technique for restoration
during dissection. Anterolateral fixation on the humerus is of shoulder abduction in brachial plexus injury. Indian J Plast Surg
important to achieve forward flexion and internal rotation 2007;40:39‑48.
in addition to the abduction. 13. Aziz W, Singer RM, Wolff TW. Transfer of the trapezius for flail shoulder
after brachial plexus injury. J Bone Joint Surg Br 1990;72:701‑4.
Drains should be left in place for one to three days 14. Kotwal PP, Mittal R, Malhotra R. Trapezius Transfer for deltoid paralysis.
J Bone Joint Surg (Br) 1998;80:114‑16.
following surgery to prevent late seroma formation and 15. Ruhmann O, Wirth CJ, Gossé F, Schmolke S. Trapezius transfer after brachial
subsequent adhesion of the muscle. plexus palsy. J Bone Joint Surg Br 1998;80:109‑13.
16. Ragab RK, El‑Sayaed AM. Modified trapezius transfer in brachial plexus
In conclusion, transfer of the upper trapezius muscle palsy. correlation of the surgical outcome with the muscle power.
with a clavicular segment for a flail shoulder can Bull Alexandria Fac Med 2008;44:621‑7.
Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015 349