Procédure microchirurgicale en cas de syndrome de Volkmann

21 mai, 2019

Microcirugía_síndrome de Volkmann_01_20190521

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A 15-year-old patient with a proximal fracture on the right forearm. She goes to the clinic of Dr. Piñal four months after a previous intervention, with severe functional limitations and a picture of pain and paralysis due to a Volkmann’s syndrome. This is a set of impacts linked to ischemic necrosis of muscles and nerves, that is because of insufficient blood flow.

Microcirugía_síndrome de Volkmann_02_EN_20190521
When she goes to the clinic of Dr. Piñal, the patient presents a pain and paralysis picture due to Volkmann’s syndrome. In the images combination above, functional limitations in the affected limb are clearly seen.

The problem

Volkmann’s syndrome usually appears associated with complications in fractures in the upper limb or with poor treatment of them (deficient immobilization, incorrect handling, etc.), although it also appears in other traumatic events such as crushing, for example.

Daños por cicatrización en el nervio mediano
In the image, damage due to scarring in the median nerve of the patient can be observed.

The goals

In this case, the clinical objectives of Dr. Piñal are aimed at the neurovascular restoration of the damaged area and the corresponding functional recovery.

The plan

In contexts such as the one in question, early withdrawal of the ‘dead’ muscles is recommended in order to avoid secondary nervous damages due to scarring, such as those suffered by the patient in her median nerve.

After removing the flexor muscles of the thumb, fingers and forearm, Dr. Piñal changes the function of the brachioradialis muscle to perform flexion of the thumb and takes a flap from the gracilis muscle of the patient’s thigh to replace the necrotic muscles of the forearm, by means of vascular and nerval microsurgical reconnection.

Procedimiento microquirúrgico
Dr. Piñal designs a microsurgical procedure that assigns a new function to the brachioradialis muscle and uses an autologous gracilis muscle transplant.
Esquema del procedimiento
Detailed scheme of the procedure

The results

The operation is a success and the patient recovers the function of the thumb and the rest of fingers of her hand.

Function of the affected limb five years after the procedure was performed by Dr. Piñal and his surgical unit.