targeted-muscle-reinnervation-surgical-protocol-for-randomized

Targeted Muscle Reinnervation: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain

Over the past decade, the field of prosthetics has witnessed significant progress, particularly in the development of surgical techniques to enhance the ...

regenerative-peripheral-nerve-interface-surgical-protocol-for

Regenerative Peripheral Nerve Interface: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain

Surgical procedures, including nerve reconstruction and end-organ muscle reinnervation, have become more prominent in the prosthetic field over the past ...

University of Alberta

Intermuscular coherence analysis can be used to assess the common drive to muscles. Coherence in the beta-frequency band (15-35 Hz) is thought to arise from common cortical sources. Intermuscular coherence analysis is a potentially attractive tool for the investigation of motor cortical excitability changes because it is non-invasive and can be done relatively quickly. We carried out this study to test the hypothesis that intermuscular coherence analysis was able to detect cortical excitability changes in healthy subjects following transcranial direct current stimulation (tDCS). tDCS has been shown to increase (anodal stimulation) or decrease (cathodal stimulation) the size of the muscle potential evoked by TMS. We found that anodal tDCS caused an increase in motor evoked potential (MEP) size that was paralleled by an increase in beta-band intermuscular coherence. Similarly, the reduction in MEP size produced by cathodal tDCS was paralleled by a reduction in beta-band intermuscular coherence, while sham stimulation did not result in any change in either MEP amplitude or beta-band intermuscular coherence. The similar pattern of change observed for MEP and intermuscular coherence may indicate similar mechanisms of action, although this cannot be assumed without further investigation. These changes do suggest that at least some of the action of tDCS is on cortical networks, and that combined tDCS and intermuscular coherence analysis may be useful in the diagnosis of pathologies affecting motor cortical excitability.

Transcranial direct current stimulation of the primary motor cortex affects cortical drive to human musculature as assessed by intermuscular coherence.

Peripheral nerve injury is common especially among young individuals. Although injured neurons have the ability to regenerate, the rate is slow and functional outcomes are often poor. Several potential therapeutic agents have shown considerable promise for improving the survival and regenerative capacity of injured neurons. These agents are reviewed within the context of their molecular mechanisms. The PI3K/Akt and Ras/ERK signaling cascades play a key role in neuronal survival. A number of agents that target these pathways, including erythropoietin, tacrolimus, acetyl-l-carnitine, n-acetylcysteine and geldanamycin have been shown to be effective. Trk receptor signaling events that up-regulate cAMP play an important role in enhancing the rate of axonal outgrowth. Agents that target this pathway including rolipram, testosterone, fasudil, ibuprofen and chondroitinase ABC hold considerable promise for human application. A tantalizing prospect is to combine different molecular targeting strategies in complementary pathways to optimize their therapeutic effects. Although further study is needed prior to human trials, these modalities could open a new horizon in the clinical arena that has so far been elusive.

Improving peripheral nerve regeneration: from molecular mechanisms to potential therapeutic targets.

Upper trunk obstetric brachial plexus injury can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and health care costs between nerve grafting and distal nerve transfers in children with upper trunk obstetric brachial plexus injury.

Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury.

Cubital tunnel syndrome has a spectrum of presentations ranging from mild paresthesias to debilitating numbness and intrinsic atrophy. Commonly, the classification of severity relies on clinical symptoms and slowing of conduction velocity across the elbow. However, changes in compound muscle action potential (CMAP) amplitude more accurately reflect axonal loss. We hypothesized that CMAP amplitude would better predict functional impairment than conduction velocity alone.

Compound Muscle Action Potential Amplitude Predicts the Severity of Cubital Tunnel Syndrome.

Overprescribing following surgery is a known contributor to the opioid epidemic, increasing the risk of opioid abuse and diversion. Trainees are the primary prescribers of these medications at academic institutions, and little is known about the factors that influence their prescribing. The authors hypothesized that differences in health care funding and delivery would lead to disparities in opioid prescribing. Therefore, the authors sought to compare the prescribing practices of plastic surgery trainees in the United States and Canada.

Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada.

Microsurgical lower extremity reconstruction remains a challenge. The use of perforator flaps in lower extremity reconstruction is expanding. The authors present an algorithm to guide in the selection of the ideal free perforator flap that can be tailored to each lower extremity defect.

Algorithm for Free Perforator Flap Selection in Lower Extremity Reconstruction Based on 563 Cases.

Patients with severe cubital tunnel syndrome often have poor functional recovery with conventional surgical treatment. Postsurgical electrical stimulation (PES) has been shown to enhance axonal regeneration in animal and human studies.

Postsurgical Electrical Stimulation Enhances Recovery Following Surgery for Severe Cubital Tunnel Syndrome: A Double-Blind Randomized Controlled Trial.

Recent evidence demonstrates that in situ decompression has comparable outcomes to other surgical techniques for cubital tunnel syndrome. However, this technique does not address the instability of the ulnar nerve, a common indication to transpose the ulnar nerve. Transposition of the ulnar nerve can potentially devascularize the ulnar nerve, stabilizing flaps block subluxation of the ulnar nerve and thereby negate the need for transposition. Flaps originating from the triceps and the flexor-pronator fascia could be used to stabilize the ulnar nerve. Herein, we present a novel intraoperative test, the "triceps traction test" and our algorithm for choosing a stabilizing flap when ulnar nerve instability is encountered after in situ decompression.

The Triceps Traction Test: A Decision Tool for the Choice of Stabilizing Flap After In Situ Decompression of the Ulnar Nerve.

The supercharge end-to-side anterior interosseous to ulnar motor nerve transfer has gained popularity over the past decade as a method of augmenting intrinsic muscle reinnervation in patients with acute neurotmetic ulnar nerve injuries. Controversy remains regarding its efficacy and appropriate clinical indications in cubital tunnel syndrome, where the timing of onset of axonal loss is less clear. The authors present guidelines for patient selection, surgical technique, and postoperative rehabilitation based on their clinical experience with the technique in this patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.

Refining Indications for the Supercharge End-to-Side Anterior Interosseous to Ulnar Motor Nerve Transfer in Cubital Tunnel Syndrome.

Partial femoral nerve injuries cause significant disability with ambulation. Due to their more proximal and superficial location, sartorius branches are often spared in femoral nerve injuries. In this article, the authors report the benefits of femoral nerve decompression, demonstrate the feasibility of sartorius-to-quadriceps nerve transfers in a cadaveric study, describe the surgical technique, and report clinical results.

Femoral nerve decompression and sartorius-to-quadriceps nerve transfers for partial femoral nerve injury: a cadaveric study and early case series.

Perforator flaps have revolutionized lower limb reconstruction by offering single-stage thin, pliable coverage with an excellent aesthetic match. Although anastomosis of the flap to a major artery remains the gold standard, perforator-to-perforator anastomosis has several advantages, including expedient recipient dissection and increased recipient options in vessel-depleted extremities. The aim of this study was to compare flap survival when a perforator or major artery was used as a recipient vessel.

Are Perforators Reliable as Recipient Arteries in Lower Extremity Reconstruction? Analysis of 423 Free Perforator Flaps.

Current classifications for cubital tunnel syndrome have not been shown to reliably predict postoperative outcomes. In this article, the authors introduce a new classification that incorporates clinical and electrodiagnostic parameters, including compound muscle action potential amplitude, to classify the preoperative severity of cubital tunnel syndrome. The authors compare this to established classifications and evaluate its association with patient-rated improvement.

ArticleTotal : 2	Year
Publication title Cited by 5	2024
Publication title Cited by 5	2024

Article	Year
Transcranial direct current stimulation of the primary motor cortex affects cortical drive to human musculature as assessed by intermuscular coherence. The Journal of physiology\| PubMed ID: 17023507	2006
Improving peripheral nerve regeneration: from molecular mechanisms to potential therapeutic targets. Experimental neurology\| PubMed ID: 25220611	2014
Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury. Plastic and reconstructive surgery\| PubMed ID: 28609352	2017
Compound Muscle Action Potential Amplitude Predicts the Severity of Cubital Tunnel Syndrome. The Journal of bone and joint surgery. American volume\| PubMed ID: 30994591	2019
Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada. Plastic and reconstructive surgery\| PubMed ID: 31246837	2019
Algorithm for Free Perforator Flap Selection in Lower Extremity Reconstruction Based on 563 Cases. Plastic and reconstructive surgery\| PubMed ID: 31397793	2019
Postsurgical Electrical Stimulation Enhances Recovery Following Surgery for Severe Cubital Tunnel Syndrome: A Double-Blind Randomized Controlled Trial. Neurosurgery\| PubMed ID: 31432080	2020
The Triceps Traction Test: A Decision Tool for the Choice of Stabilizing Flap After In Situ Decompression of the Ulnar Nerve. Techniques in hand & upper extremity surgery\| PubMed ID: 31764486	2020
Refining Indications for the Supercharge End-to-Side Anterior Interosseous to Ulnar Motor Nerve Transfer in Cubital Tunnel Syndrome. Plastic and reconstructive surgery\| PubMed ID: 31881618	2020
Femoral nerve decompression and sartorius-to-quadriceps nerve transfers for partial femoral nerve injury: a cadaveric study and early case series. Journal of neurosurgery\| PubMed ID: 33157531	2020
Are Perforators Reliable as Recipient Arteries in Lower Extremity Reconstruction? Analysis of 423 Free Perforator Flaps. Plastic and reconstructive surgery\| PubMed ID: 35080525	2022
Classifying the Severity of Cubital Tunnel Syndrome: A Preoperative Grading System Incorporating Electrodiagnostic Parameters. Plastic and reconstructive surgery\| PubMed ID: 35544306	2022

Hollie A. Power

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