Reconstrucción de heridas complejas de miembro superior con lesión alta de nervio radial mediante transferencias tendinosas
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Fecha
2024
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
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Introducción: Las transferencias tendinosas son una herramienta terapéutica en pacientes con lesiones crónicas del nervio radial; en muchos casos una de sus indicaciones va determinada debido a la no posible reparación del nervio radial por diversos factores. En lesiones agudas del nervio, su indicación es controvertida, ya que la reparación del mismo representa el manejo ideal. El factor determinante en nuestro medio para el uso de las transferencias tendinosas en pacientes con lesiones agudas del nervio radial va sujeto a la dificultad de realización de fisioterapia postoperatoria, lo cual en gran parte es debido tanto a la población que se maneja localmente como a las adversidades relacionadas en sus procesos administrativos para su ejecución. Existen diferentes tipos de transferencias tendinosas según los autores, variando en el músculo donante a transferir, cada una mostrando sus ventajas y desventajas. Métodos: Se realizó un estudio descriptivo, en donde se presentan 4 casos de pacientes con lesiones de nervio radial alta, a quienes se les realiza transferencias tendinosas de acuerdo con la experiencia en el servicio. Resultados: La lesión del nervio radial crea una discapacidad significativa y funcional en la mano, por lo cual a través de transferencias tendinosas se realizó ferulización interna para mejoría en la funcionalidad de la extremidad, ya que nos encontramos en un medio en el cual las opciones adquisitivas de terapias de rehabilitación son inconstantes, y en muchos casos de inicio tardío a lo necesitado. En lesiones altas de nervio radial, las transferencias tendinosas tienen una indicación controvertida ya que en la literatura se demuestra que la reparación nerviosa inmediata es el manejo ideal, sin embargo, en nuestro medio encontramos varios factores que determinan el uso de esta técnica, puesto que en pacientes de áreas rurales no es accesible fácilmente la realización de terapias físicas que se requieren para una buena recuperación postoperatoria. Lo cual en gran parte es debido a la población que se maneja localmente como a las adversidades que se presentan en sus procesos administrativos. Conclusión: Realizando transferencias tendinosas tempranas para ferulización interna se logró demostrar la mejoría en la calidad de vida de los pacientes de este medio y así facilitar la recuperación y reintegro laboral tempranamente. El uso de transferencias tendinosas en lesiones altas de nervio radial en población con factores predisponentes a mala adherencia al manejo postoperatorio se vio como buena opción quirúrgica para reintegro tempranamente a sus labores cotidianas y mejor funcionalidad de la mano.
Introduction: Tendon transfers are a therapeutic tool in patients with chronic radial nerve injuries; in many cases one of their indications is determined due to the inability to repair the radial nerve due to various factors. In acute injuries of the nerve, its indication is controversial, since its repair represents the ideal management. The determining factor in our environment for the use of tendón transfers in patients with acute injuries of the radial nerve, is subject to the difficulty of performing postoperative physiotherapy, which is largely due to both the population that is managed locally and the adversities related to the administrative processes for its execution. There are different types of tendón transfers according to the authors, varying in the donor muscle to be transferred, each one showing its advantages and disadvantages. In this article we present our experience with the use of tendon transfers for the management of acute radial nerve injuries. Methods: a descriptive study is carried out, in which 4 cases of patients with high radial nerve injuries are presented, who underwent tendon transfers according to the experience in the service. Results: the radial nerve injury creates a significant and functional disability in the hand, so through tendon transfers we perform internal splinting to improve the functionality of the limb, since we are in an environment in which the acquisitive options of rehabilitation therapies are few. In high radial nerve injuries, tendon transfers have a controversial indication since the literature shows that immediate nerve repair is the ideal management, however in our environment we found several factors that determine the use of this technique, since in patients from rural areas the physical therapies required for a good postoperative recovery are not easily accessible. This is largely due to the population that is managed locally as well as the adversities that arise in their administrative processes. Conclusion: By performing early tendon transfers for internal splinting, we were able to demonstrate an improvement in the quality of life of patients in this setting and thus facilitate recovery and early return to work. The use of tendon transfers in high radial nerve injuries in a population with predisposing factors to por adherence to postoperative management was seen as a good surgical option for early reintegration to daily work and better hand functionality.
Introduction: Tendon transfers are a therapeutic tool in patients with chronic radial nerve injuries; in many cases one of their indications is determined due to the inability to repair the radial nerve due to various factors. In acute injuries of the nerve, its indication is controversial, since its repair represents the ideal management. The determining factor in our environment for the use of tendón transfers in patients with acute injuries of the radial nerve, is subject to the difficulty of performing postoperative physiotherapy, which is largely due to both the population that is managed locally and the adversities related to the administrative processes for its execution. There are different types of tendón transfers according to the authors, varying in the donor muscle to be transferred, each one showing its advantages and disadvantages. In this article we present our experience with the use of tendon transfers for the management of acute radial nerve injuries. Methods: a descriptive study is carried out, in which 4 cases of patients with high radial nerve injuries are presented, who underwent tendon transfers according to the experience in the service. Results: the radial nerve injury creates a significant and functional disability in the hand, so through tendon transfers we perform internal splinting to improve the functionality of the limb, since we are in an environment in which the acquisitive options of rehabilitation therapies are few. In high radial nerve injuries, tendon transfers have a controversial indication since the literature shows that immediate nerve repair is the ideal management, however in our environment we found several factors that determine the use of this technique, since in patients from rural areas the physical therapies required for a good postoperative recovery are not easily accessible. This is largely due to the population that is managed locally as well as the adversities that arise in their administrative processes. Conclusion: By performing early tendon transfers for internal splinting, we were able to demonstrate an improvement in the quality of life of patients in this setting and thus facilitate recovery and early return to work. The use of tendon transfers in high radial nerve injuries in a population with predisposing factors to por adherence to postoperative management was seen as a good surgical option for early reintegration to daily work and better hand functionality.
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Palabras clave
Transferencias tendinosas, Lesión nervio radial, Reconstrucción nerviosa, Tendon transfers, Radial nerve injury, Nerve reconstruction