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31-JULY-2002 AMAL ALI SALEM 22 YEARS AVULSION
INJURY LOWER TRUNK RIGHT BRACHIAL PLEXUS.
Comments
The surgery is a major one and the result
is below expectation. At least the minor improvement is
better than nothing.
Anamnesis
The patient a Yemeni citizen, came to the clinic
11-July-2002, telling that she suffered RTA 5
months ago (13-February-2002) with LOC for 30
min, admitted to Hadhramout hospital with severe
pain right elbow, for what nailing was performed
07-April-2002 for dislocation of the head of the
humerus? She has neck pain for 4 days.
On examination: The patient has complete
paraplegia of the right deltoid, biceps,
flexors, extensors of the forearm, flexion,
extension of the right hand and the right
triceps muscle. There is analgesia of the C5
down to C7 roots territory right upper limb.
There is an incision anterior to the right
deltoid extending up supraclavicular. What and
when it was done remain unknown.
The patient was sent for investigation and MRI
cervical spine showed avulsion of the right C7,
8 and D1.
Incision over the projection
of C5 and C5 was created to expose the C4 and C5
roots right side. The old scar refreshed and
turned to the chest to expose both the brachial
plexus under the clavicle and the intercostal
nerves. The subclavian vein seen and preserved.
The medial division of the median nerve
identified. The subclavian artery isolated. The
right sural nerve was harvested. Tunneling of
the incisions above and below the clavicle for
the sural grafts. The phrenic nerve and dorsal
branch of C4 anastomosed with the right ulnar
nerve. The same was done with the medial origin
of the right median nerve. The second right
intercostal nerve identified and dissected up
and transposed to the bundle area to be directly
anastomosed with the medial branch of the right
median nerve. The wounds were closed.
Smooth postoperative
recovery.
Follow Up
The patient came to the clinic 10-August-2002
with clean wound and the right deltoid and
biceps and triceps 2/5. The right
brachioradialis 2/5. There is hypalgesia median
distribution and analgesia ulnar distribution.
The patient then came 05-August-2003 with
no proper improvement of the left ulnar nerve.
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Leica HM500
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
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After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
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LooksCam II Xenosys in the run starting from 14-March-2021 with
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Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
