Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation

Wide-awake surgery is transforming many areas of hand surgery. We report a distinctive case of an avulsion near total amputation of the right dominant arm, which required emergent shaft humerus fracture fixation and brachial artery repair with a vein graft. Three months post-injury, the patient unde...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2022-09, Vol.14 (9)
Main Authors: Sankaran, Ajeesh, Thushara, K R, Ajaykumar, V, Mohankumar, E G
Format: Article
Language:English
Subjects:
Amputation
Case reports
Elbow
Hand surgery
Injuries
Local anesthesia
Orthopedics
Plastic surgery
Skin & tissue grafts
Trauma
Veins & arteries
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Summary:Wide-awake surgery is transforming many areas of hand surgery. We report a distinctive case of an avulsion near total amputation of the right dominant arm, which required emergent shaft humerus fracture fixation and brachial artery repair with a vein graft. Three months post-injury, the patient underwent long segment nerve grafts of the median and ulnar nerves, with pectoralis major to biceps transfer for elbow flexion reconstruction. Since the patient failed to gain any functional movement of the elbow, we explored the transfer under wide-awake local anaesthesia using lignocaine and adrenaline. Four months after the wide-awake release, the patient had gained 70 degrees elbow flexion against gravity and 110 degrees with gravity eliminated. On the Waikakul scale, the result was categorized as 'Good'. Wide-awake anaesthesia allowed sufficient release of a large muscle transfer in a prior traumatised zone with a satisfactory result.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.28837