Pronator Teres (PT) to the Extensor Carpi Radialis Brevis (ECRB) Tendon Transfer
This chapter details the surgical steps involved in tendon transfer from the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) to restore wrist extension in patient with high radial nerve palsy. Pronator teres tendon is harvested and transf
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Odette Abou Ghanem and Joseph Y. Bakhach
Indications High Radial Nerve Palsy 1. Radial nerve palsy results in an inability to extend the wrist and the finger metacarpophalangeal joints and to extend and abduct the thumb, the so-called wrist drop deformity. 2. The loss of wrist extension weakens the power grip. 3. The loss of finger and thumb extension affects the ability to grasp objects. 4. Radial nerve palsy is important to differentiate from posterior interosseous nerve (PIN) palsy because in the latter the extensor carpi radialis O.A. Ghanem, M.D. (*) Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Fourth Floor, Sami Bershan Building, Cairo Street, Hamra, Beirut 1107-2020, Lebanon e-mail: [email protected]; oa25@aub. edu.lb J.Y. Bakhach, M.D. Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Fourth floor, Cairo Street, Hamra, Beirut 1107-2020, Lebanon
longus (ECRL) innervation is spared and patients can still extend the wrist, although with radial deviation and the sensation over the dorsum of the first web space is preserved. 5. The pronator teres (PT) to the extensor carpi radialis brevis (ECRB) transfer is done for wrist extension restoration of function. Patients with PIN palsy do not require this transfer since wrist extension is preserved. 6. Tendon transfers for radial nerve palsy including the PT to ERCB are considered in the following cases: (a) Delay in presentation of the radial nerve injury beyond one year (b) Failure in motor function recovery after repair/reconstruction of the injured radial nerve (c) Failure in motor recovery after decompression of the radial/posterior interosseous nerve
Possible Complications 1. Persistent wrist drop deformity due to a loose PT tendon transfer 2. Excessive extension and lateral deviation of the wrist due to an excessive tightening of the PT tendon transfer
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_129
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O.A. Ghanem and J.Y. Bakhach
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Essential Steps Preoperative Testing 1. Patients must have a good passive range of motion at the wrist to get a good result from the tendon transfer. 2. Clinical muscle testing and careful examination are essential to identify the functional deficits and the available tendons that can be transferred.
abduction and extension, and the finger interphalangeal joints are left free. 2. On postoperative day 10, the sutures are removed and the wound is inspected, and a removable splint is kept for 4 weeks maintaining the wrist and fingers in the position described above. 3. After 4 weeks tenodesis exercises need to be started with a physical therapist.
Operative Dictation Intraoperative Details 1. Procedure is done under tourniquet control. 2. A 6 cm longitudinal incision is made over the volar radial aspect of the mid-forearm. 3. The forearm fascia i
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