Utilization of Dual Venous Flaps in the
Reconstruction of Defects on the Extensor Aspect of Upper Extremities
Ibrahim
ASKAR*, Mehmet BOZKURT*
* Dicle University Medical
School Dept. of Plastic and Reconstructive Surgery, Diyarbakır
There have been many
surgical techniques defined for repair of defects of the extensor aspect of
upper extremities. In the aspect of vascularity, venous flaps have been
popularized recently. For the last four years, 13 patients with skin lesions of
the extensor aspect of forearm and hand were admitted to our clinic. After
excision of the lesions, the resultant tissue defects were repaired with dual
venous flaps. The sizes of flaps varies from 3x4-cm to 4x6-cm. In the dual
venous flaps, two veins supplying venous flaps have capillary interconnections.
So it is different from type 2 venous flaps since type venous flaps have only
one vein lying although the flap. Dual venous flaps had no patchy necrosis. On
the other hand, edema occured and pinkish color was seen as seen in random
pattern flaps and island pedicled flaps. Those showed that use of dual venous
flaps decreased the risk of necrosis. Today there is a challenge for the use of
venous flaps in the hand reconstruction. And we believe that utilization of
dual venous flaps gives better results especially in the repair of defects,
except for large ones.
Our
Experience in Gunshot Injuries of the Hand
Mehmet BOZKURT, Fatih ZOR, İbrahim AŞKAR,
Yalçın KÜLAHÇI, Yalçın BAYRAM
High energy injuries of the hand constitutes a challenging problem for hand
surgeons. Battlefield injuries are among the most severe injuries. They not
only cause bone and soft tissue injury but composite tissue defects also. So
treatment of these injuries are difficult and needs both experience and multidisciplinary
approach. Here we want to present our experience about gunshot injuries of the
hand.
Between 2001-2005, 37 hand injuries due to gunshots were treated in
Diyarbakır and Çorlu Military Hospital. The average age of the patients was
24.6 (18-36 years) and all patients were male. All patients except 4 were
accepted to hospital in first 24 hours and underwent to operation. Patients
were underwent to serial debridements and after 2-3 debridements definitive
surgical operation is performed. For reconstruction of bone injuries osseous
posterior interosseous flap was used in 4 patient. Bone grafts were used 6
patients. In other cases the bony skeleton was repaired with external or
internal fixation. For soft tissue reconstruction kite flap (3 cases),
hetererodigital flap (1 case), reverse RFF (1 case) and skin graft (12 cases)
were used. In 5 patients 7 digital amputations and stump closure was performed.
All patients were undertaken to rehabilitation program at the early period.
Despite very aggressive treatment functional problems were present in some
cases but all cases except 4 returned to their work at 6 months period. Digital
amputations caused serious psychologic problem to the patients. As a
conclusion, treatment concepts of these injuries include identification of
injured structures, aggressive surgical wound care, and reconstruction of
important functional structures. Civilian gunshot wounds to the hand are
typically caused by low-velocity weapons but military gunshot injuries are
cause by high velocity weapons such as rifle, mine explosions, rocket
explosion. So these wounds compose a large area and contaminated. High-energy
injuries are complicated by significant tissue destruction, rehabilitation
dilemmas, and uncertain outcomes. The surgeon must recognize the anatomic
complexity of the hand and proceed with caution. Most gunshot injuries to the
hand involve a combination of tissue types. Bone injury is dramatic and is seen
radiographically. However, injury to the soft tissue including skin, tendon,
blood vessel, and nerve also must be appreciated. Individually, the tissues
have varied function and properties of healing. Therefore, the challenge is to
prioritize the injury, select an aggressive surgical approach, and integrate a
suitable rehabilitation plan
Double Reverse V-Y-Plasty: 8 Years’ Experience
Ibrahim Askar*, Mehmet Bozkurt*, Emin Kapi*, Fatih Zor**
* Dicle
University Medical School Dept. of Plastic and Reconstructive Surgery,
Diyarbakır.
** GATA Dept. of Plastic and
Reconstructive Surgery, Ankara
Many surgical techniques
have been defined for treatment of postburn contractures. We present the
results of 8 years’ experience of our technique, double reverse V-Y-plasty. Up
to now, we applied this technique to 142 patients, however, we could follow
only 107 patients. And we recorded those patients. Out of 107 patients, 47 had
postburn contractures on the upper extremities. All have been treated with
double reverse V-Y-plasty. Two patients had postburn contractures on the upper
and lower extremities and both also treated with double reverse V-Y-plasty.
There is no evidence of flap necrosis postoperatively. Long-term follow up
showed that all contractures were released completely. However, in 11 patients,
functional recovery could not be obtained since joint ankylosis developed.
Traditional techniques
that have been used have a major disadvantage of distal flap necrosis since
postburn sicatricial tissue has poor blood supply. Other disadvantage of
Z-plasty and V-Y-plasty is the excision of excess tissue as dog ear
deformity. Advantages of
double reverse
V-Y-plasty: i) Suture line is primarily closed easily without tension. ii) It
is superior to other techniques in superficial burn scars since those tissues
have sufficient vascularity and mobility. iii) It can easily be used by the
inexperienced surgeons. iv) Color and texture of postoperative scar tissue is
cosmetically acceptable, and the resultant postoperative contracture is
superior to other traditional techniques. v) There is no evidence of “dog ear”
deformity. vi) Only local anesthesia is required. vii) It shortens the time
period of operation and hospitalization
Comparison of Post Operative Early Active and Passive Mobilization of
Flexor Tendon in Zone
Maryam Farzad
Iran
Objective The purpose of this study was to compare the result of
50 digits treated by either “Early active mobilization” or “controlled passive
mobilization” regimen in Iran hand rehabilitation center.
Method Patient being matched for gender , age,
injuries hand, technique of surgery (all with epitenon first, four strand) in
two groups. They were assessed 8 week postoperating in respect of total active
motion, flexion gap and extension lag. Outcome were defined using “Strickland”
and “Buck-Gramko” criteria.
Findings The result were 80%excellent and good, 20% fair and no
poor in early active motion group and in second group 40% excellent and good
,44% fair and 16% poor due to Strickland criteria .in buck-gramcko criteria
passive group 15% excellent and good ,24% fair and 16% poor and in active group
52%excellent and good , 32% fair and 16% were poor .Mean of total active motion
was significantly greater in early active motion group(t.test with equal
var:-3.33 and p<0.001).
Conclusion Actively mobilized tendon underwent intrinsic
healing without large gap formation. Active motion generated both tension and
motion and offer several advantage over passive motion: improved tendon
nutrition, less adhesion, higher rate of healing, increased ultimate rang of
motion. So early active motion is the best protocol for treating tendons in
zone 2.Our result is comparable with this theory.
The Use of Plaster
Cylinder Casting for Contracture of the Interphalangeal Joints
Maryam Farzad
Iran
Plaster
cylinder serial casting of interphalangeal joints of fingers began as an idea
in the hand rehabilitation center established in the 1960 in vellore, India, by
Paul Brand, MD, As experienced by brand, the technique is not one of
progressive stretching but of growth. The cells of the contracted tissue are
stimulated to grow and become internally rearranged or modified by being held
in the maximum possible extension. This is why the process takes time and
position must be held for a period of time there is no chance for remodeling to
take place in an hour or two each day or every other day the joint can be
recasted. In this survey 28 samples with flexion contracture in PIP joint that
were referred to Iran hand rehabilitation center were treated by cylindrical
casting. In the beginning of treatment sample were evaluated by T.A.M, flexion
contracture, and lexion gap. In one month every other day joints were recasted,
and between casting wax bath, oil massage and exercise were used for the
patients in re evaluating mean of T.A.M was superior than first evaluation
(from 88.51 to 130.18) mean of flexion contracture was decreased (from 37.59 to
8.14), mean of flexion gap was decreased too. (From 4.37 to 2.37). Findings
show that this method is a useful method for treating flexion contractures
without limiting in range of motion.
Patient Satisfaction Following Carpal
Tunnel Decompression: A Comparison of Patients with and without Osteoarthritis of
the Wrist
S Joshy, B Thomas, SG Haidar, S Ghosh,SC
Deshmukh,
City Hospital, Birmingham, UK
Aim We compared patient
satisfaction following carpal tunnel decompression between patients with and
with out osteoarthritis of the wrist.
Patients and Methods The study was done retrospectively. Clinical notes of
all the patients who underwent carpal tunnel decompression over a period of 8
years were verified. Twenty-four
patients who underwent surgical decompression for carpal tunnel syndrome,
secondary to osteoarthritis were identified. Control group consisted of 24
patients matched for age, sex, side, and neuro-physiological severity, who
under went carpal tunnel decompression, but without osteoarthritis of the
wrist.
Results The mean age of the
patients was 71 years (range 33-89 years). There were 19 females and five
males. In the group with osteoarthritis of the wrist 17(71%) patients reported
the their symptom relief as satisfactory and the rest seven(29%) reported the
results as unsatisfactory. In the control group 23(96%) patients reported their
symptom relief as satisfactory and one (4%) reported their results as
unsatisfactory (P<0.05).
Conclusions Patient satisfaction
following surgical decompression, in patients with secondary carpal tunnel syndrome
due to osteoarthritis is significantly lower compared to patients with out
osteoarthritis of the wrist.
The Effect of Myofascial Release and Nerve
Mobilization in the Conservative Treatment of Carpal Tunnel Syndrome
Katleen Meeûs,
Physical therapist at the University hospital of Leuven
Abstract text Current local conservative
treatment of carpal tunnel syndrome (CTS) is in most cases ineffective, leaving
in the end no other option than surgery.
In order to prevent the risks of surgery, the conservative treatment is
gaining importance. However, it has not
been adequately explored yet. Inspired
by research in this area, an experimental comparative study was set up in order
to evaluate the effect of soft tissue techniques on the neural container of the
median nerve in patients with CTS and to compare these effects with the local
treatment. CTS is a local peripheral
entrapment in the carpal tunnel but there are vascular a nutritional
consequences noticeable on the whole track of the median nerve, so the soft
tissue techniques were applied from the cervical origin to the distal palmer
side of the hand. In total twenty
subjects with CTS were treated and evaluated.
They were all evaluated at three points in time. The first evaluation was before
treatment. The motor and sensory distal
latency was measured, a clinical evaluation was made by means of the
‘phalen-test’ and the ‘Upper limb neurodynamic test’ for the median nerve
(ULNT1-reversed) and in order to evaluate the subjective symptoms the ‘DASH’-
questionnaire (Disabilities of the arm, shoulder and hand) was filled out by
the subject. The second evaluation 1
week after the treatment contained only the clinical tests and the
questionnaire to determine the short-term effect. In order to determine a longer-term effect, a third evaluation
was made four weeks after the treatment with the same tests as the first
one. Ten subjects were given 8
experimental treatment sessions over a period of 4 weeks, being a myofascial
release of the containing structures of the median nerve, digital flexor tendon
gliding and gliding of the median nerve.
The control group, also consisting of ten subjects underwent a local
conventional treatment (ultrasound and/or electro-therapy) over the same
period.
Despite the small sample, the Fisher exact test revealed significant
evidence for a treatment effect. This
was captured by the ULNT, the Phalen test and the Dash score. The observed results were better in the
experimental group than in the control group 4 weeks after treatment in 90%
(p<0.0001) and in 87.5% (p=0.003) of the subjects for the ULNT and the
Phalen test respectively. For the Dash
score the treatment effect was already present 1 week after the treatment (p<0.0001)
and it remained present after 4 weeks (p=0.0002), whereas for the clinical
tests, there was no evidence yet after 1 week. There was no significant
evidence for a treatment effect using the distal latency measurements. It is possible that the recuperation of the
median nerve was not yet measurable 4 weeks after the end of treatment.
The results should be put in perspective the size of the sample and the
lack of electro diagnostic evidence.
Acute Compartment Syndrome of Upper Arm
Rafiq I,
Shakeel M., Jehan S,
Anderson
D.J.
Clinical Research Fellow, Wrightington Hospital, WWL
NHS Trust,
Greater
Manchester, United Kingdom
Introduction Compartment syndrome occurs when pressure within a closed muscle
compartment exceeds the perfusion pressure and results in muscle and nerve
ischemia. The condition is very
rare in upper arm. The common causes in arm is trauma, burns, infections,
heroin or carbon monoxide intoxication, Fracture neck of Humerus, Triceps
avulsion and contusion but rare causes are steroid use and prolonged pressure
on the arm during sleep or unconsciousness as a result of alcohol or other
drugs.
Case report: 54 year-old
gentlemen presented to us with pain and marked swelling in his left upper arm.
He was found in semi-conscious state in his house after a heavy binge drinking
over night. The past history included the hypertension and depression. The
vital signs were normal although he was drowsy with GCS of 14/15.There was no
other injury. The pulses in left arm were palpable although there were altered
sensations in hand and arm. The active flexion was restricted to 45 degrees and
pain intensified on passive flexion that was limited to 90 degrees. The compartment pressure in the arm was
measured immediately which was 32 mmHg but rose to 49 mm Hg after 1 hour. The
blood showed W.B.C of 27.1, urea 7.3mmol/l, creatinine 323uml/l, K 6.9 meq/l,
GGT 58 u/l and creatinine kinase (C.K) of 61000u/l (normal 10-186 u/l). The
diagnosis of upper arm compartment syndrome was made. It was also obvious that
the patient had rhabdomyolysis resulting to acute renal failure, as he became
oliguric. The immediate faciotomy of arm was done extending from acromion
arcing over the deltoid and biceps down to extensor compartment of the arm.
There was no obvious muscle necrosis. The patient was admitted to H.D.U as he was
started with haemodialysis. The wound was closed on 8th day after 3simaltaneous
wound examinations and debridement under G.A for later muscle necrosis. The
patient needed the haemodialysis for one month after which he regained his
renal function. On discharge he was able to regain the full function of the
arm.
Discussion Morbidity and mortality from compartment syndrome stem
from a delay in treatment or diagnosis. The clinical signs and symptoms of
compartment syndrome are pain out of proportion to clinical situation, a
palpably tense compartment, pain with passive muscle stretch, paresis and
paresthesia. Muscles were noted to have functional impairment after 2 to 4
hours and of ischemia and irreversible functional loss after 4 to 12 hours.
Nerves have found to show abnormal function after 30 minutes of ischemia with
irreversible functional loss after 12 to 24 hours. Rhabdomyolysis and subsequent renal failure are among the most
severe complications as a result of muscle necrosis.
Serial CK measurements may show rising levels indicative of a developing Compartmant
syndrome. Muscle has considerable ability to regenerate by forming new muscle
cells. Therefore, it is extremely important to decompress ischemic muscle as
early as possible. In medical literature Fasciotomy has been proposed when
compartment pressure rises within 10 to 30 mmHg of diastolic pressure. If the
compartment pressure is more than 40 mm Hg, a fasciotomy is usually performed
emergently. We stress on the early diagnosis of condition with appropriate
history and clinical examination and a low threshold for surgical exploration
and fasciotomy is advocated.
Clinimetric Properties of the Duruöz Hand Index in
Patients with Stroke
Sezer N*, Yavuzer G**, Sivrioğlu K***, Başaran P**, Köseoğlu F*
*Ankara Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi,
Ankara
**Ankara Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon
Anabilim Dalı, Ankara
***Uludağ Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon
Anabilim Dalı, Bursa
Background and
purpose Duruöz Hand Index
(DHI) is a self reported questionnaire developed to assess hand ability in the
kitchen, during dressing, while performing personal hygiene, office tasks, and
other general items. The purpose of this study was to examine validity,
reliability and responsiveness of the DHI in hemiparetic patients with stroke.
Methods Eighty-five patients with stroke
were enrolled from 3 rehabilitation centers. Body function/structures of the
hand and upper extremity were assessed in terms of motor recovery (Brunnstrom’s
Motor Recovery Stage-BMRS), spasticity (Modified Ashworth Scale-MAS), and
sensation (touch and joint position). Self-care sub-items (eating, grooming,
bathing, dressing upper body, dressing lower body, toileting) of the Functional
Independence Measure (FIM) and the DHI were used to measure activity
limitation. Two baseline measurements 1 day apart (n=85) and 1 follow-up
measurement (n=56) immediately after 4 weeks of inpatient rehabilitation
program were performed. Test-retest reliability of the DHI was determined
between first and second assessments using intraclass correlation coefficient
(ICC). Internal consistency of baseline DHI was measured by Cronbach’s α.
Construct validity was assessed by correlating the DHI scores with FIM
self-care scores (Pearson Correlation Coefficient). Responsiveness to change
was assessed by Paired Samples T Test comparing second and third assessments before
and after 4 weeks of rehabilitation program.
Results Mean±SD of age and time since
stroke of the patients (40% woman, 47% right hemiparesis) were 61.2±12.9 years
and 46.9±51.9 months, respectively. All assessed parameters were improved
significantly after rehabilitation (p<0.05). The correlation between DHI,
and FIM-self-care measurements (r=-0.35, p<0.001), BMRS (r=-0.40,
p<0.001), and sensation (r=0.31, p<0.001) was statistically significant.
Internal consistency (α=0.97) and test-retest reliability (ICC=0.99) of
the DHI was high.
Conclusion The DHI showed
an acceptable level of validity, reliability and responsiveness in assessing
activity limitation of hemiparetic patients with stroke.
The Clinical Results of Kleinert Method Early Mobilization and Early Active
Mobilization after Isolated Flexor Tendon Injuries
Şenen D., M.D., Sevin A., M.D.,
Deren O., M.D. Erdoğan B., M.D., Akyüz Erman M. Pht.
Ankara Numune Hospital 1st Plastic and Reconstructive Surgery Clinic,
Ankara
Objectives In our
study, between 2000 and 2002 , 100 isolated flexor tendon injuries
( group I) were repaired with modified Kessler sutures and after repair, all patients were rehabilitated by Kleinert method . Between 2002-2005 100
isolated flexor tendon injuries (group
II) were repaired by the same technique (modified Kessler Suture) and
rehabilitated by early mobilization and results are given.
Both results are
analyzed with Buck-Gramco system.
Results In group I, 100
patient with isolated flexor tendon
injuries (82% male and 18% female and
patients’ ages are between 15 and 70) )
were repaired with modified Kessler sutures Patients were rehabilitated with Kleinert method.
According to Buck-
Gramco system; the results are given:
10. 2% were excellent,
48,1% good22,8% fair18,9% poor
Unilateral grip: 20.7%
excellent ,48.3 %good, 37,2% fair
Bilateral grip: 20,7%
excellent, 55,2% good, 24,1% fair
In group II, 100 patient
with isolated flexor tendon ınjuries
(%77 male and %23 female and patients
ages are between 17-65 ) with isolated flexor tendon injuries were repaired
with modified Kessler sutures. Patients
were rehabilitated with early mobilization.
According to Buck-
Gramco system; the results are given:
22,7% excellent, 61,9%
good, 11,7%fair, 3,7% poor
Unilateral grip: 49,1 %
excellent, 45,6 %good, 5,6 % fair
Bilateral grip: 52,7 %
excellent, 42,3% good 5,0 %fair
Conclusion According to results of repair in both groups, we get better results in early mobilization group
Clinical Experience of the Bening and Malign Tumor
of the Hand
Şenen D., M.D., Adanalı G., M.D., İbrahimoğlu D. M.D. Atakul D. M.D.
Erdoğan B., M.D.
Ankara Numune Hospital 1st Plastic Surgery
In this poster, the
patients who were operated for the tumoral lesions on the hand between 2002 and 2005 in our clinic are
presented
Patients and Methods 60% of the
patients were male and 40% were female. The
ages of patients were between 15 and 80.
30% of patients had
malign tumors with includes skin and some were involving both skin and bone .
70% of patients had
benign tumors including Pyogenic granuloma, ganglion cyst, verruca vulgaris resistant to medical
therapies, and sebaceous cyst.
80% of patients were
male and 20% were female.
21 malign tumors were
squamous cell ca. 6 were basal cell ca. 1 were malign melonoma and 2 were
enchondroma.
Results In 21 patients
with squamous cell ca, 15 of them had tumor on the dorsum of the hand.
Four defects after excision of the
lesions which were localized on the dorsum of the hand, were closed primarily.
Eleven defects which
were not suitable for primary closure
after excision were reconstructed with
split thickness skin grafts.
Six patients who had
squamous cell ca. were on fingers and one of them were excised and defect were
closed primarily. 5 patient had ray amputation.
6 of the tumors localized on the dorsum of the hand were
basal cell ca. and four of them were
primary closed after excision . Two had
reconstructed with split thickness skin graft.
One patient had ray
amputation because of malign melanoma.
According to
histopathologic examination, 70% of
lesions were benign, 3 were hemangioma, 35 were ganglion cyst, 5
were xantoma, 2 were lipoma, 4 were recurrent verruca vulgaris which were
resistant to other medical therapies, 19 were pyogenic granuloma.
Conclusion 70 % of patients
who were operated in our clinic between
2002 and 2005 were benign. One of the
patients who had squamous cell
ca, soon had lung metastases and he had chemotherapy and radiotherapy .
One patient had operated again because of recurrence
and the extremity was amputated from
proximal forearm level .After the operation chemotherapy and radiotherapy were given.
Patiens were followed
monthly for the first three months, then in every three months for the next 9
months. If there is no recurrence 1
year after surgery, following up
visits are programmed in every 6 months for 5 years.
80% of patients were
farmers who had sun exposure for long period of time. All patients were well
informed for protecting their skin from sunlight and post operative follow up visits were done very carefully to avoid
skipping recurrence or new lesions.
Obstetrical Brachial Plexus
Injuries and Rehabilitation: Results of 60 Babies
Tugay N*, Karaduman A**, Tugay U*
* Muğla University, Muğla School of Health, Muğla, Turkey
** Hacettepe University School of Physical Therapy and Rehabilitation,
Ankara, Turkey
Objectives This study is
conducted to investigate the effectiveness of rehabilitation on children with
obstetrical brachial plexus palsy.
Material and Methods:
The study was conducted on children between 0-12 months. All the patients were
followed during the first year of their lives regularly with home based
rehabilitation program. Families who were referred immediately after diagnosis
were advised to support the child’s paralyzed arm in neutral position for 3
weeks and after this period according to the physiotherapy evaluation results
of the movements of the arm passive, active assisted or active range of motion
(ROM) exercises were recommended. Risk factors effecting the progress and
intensity, motor improvements were evaluated and also anthropometric
measurements were performed.
Results At the end of one year, 22 children (%36.66) recovered completely, 17 children
(%28.66) underwent surgery and 21 children (%35) recovered not completely. The
significant difference between the birth weights of the children and their
siblings (p< 0.05) showed that high birth weight is the most important risk
factor.
Conclusions Supporting the paralyzed arm in neutral
position fort he first 3 weeks and than giving ROM exercises according to the
improvement of the arm have great importance in preventing the contractures.
Age of 6 months can be considered as the criteria for surgical decision,
because the improvement rate was found in its highest speed during this time
and then reaching to a plateau after 6 months.
Interdigital Pilonidal Sinus: A Rare Occupational
Disease of Male Barbers’
Muhammet Uraloğlu MD, Hakan Orbay MD, Ahmet Çağrı Uysal MD, Asu Deniz
Yılmaz MD, Ramazan Erkin Ünlü MD, Ömer Şensöz MD
Ankara Numune Hospital 2nd Plastic and Reconstructive Surgery Department
Introduction
Interdigital pilonidal sinüs is an occupational disease of male barbers’.
Histologically it is a reactive foreign body granuloma. Disease is due to the
penetration of hairs through the soft
interdigital web skin and subsequent tissue reaction and inflammation
leading to a sinus or cyst formation. The commonest symptom is the purulent
drainage from the sinus track.
Case report The patient was a 28
year old male barber. He admitted to our department with the complaint of
purulent drainage from the 3rd interdigital web of right hand. He was operated
under local anesthesia. First of all methylene blue injection into the cyst was
carried out in order to determine the borders of the cyst. Later excision was
carried out. Macroscopically hairs in different colors and lengths are
observed. Defect was closed primarily.
Result Patient was followed up
for 6 months. No complication or recurrence was observed.
Division Variations of Brachial Plexus in Human
Newborns
Acer
N*, Ekinci N**, Tugay U*
*Assist. Prof. Dr. Muğla University, School
of Health Sciences, Muğla/Turkey
** Assoc. Prof. Dr. Erciyes University,
Medical Faculty Kayseri/Turkey
Objectives This study is conducted to examine the anatomic variations of the brachial
plexus (BP) in human newborns.
Material and Methods BPs’ of 28 newborns cadavers were examined in this study. The plexuses were
dissected and after completion of the dissection under a microscope (Nikon Type
104 SMZ 800), the normal position and/or morphological variations of anterior
and posterior divisions of the BP were assessed and sketched.
Results: Division
variations were observed frequently. Of 28 brachial plexuses examined, division
variations were observed at 6 cases (20.2 %).
Conclusions The knowledge of the anatomical variations of the peripheral nerve system
can help clinicians in explaining incomprehensible clinical signs and it may be
important for surgeons while performing surgical interventions in the cervical
and axillary regions. High variation rate in brachial plexus found in the
present study could be due to an incomplete development of the brachial plexus
in the newborn. Further studies investigating the variations in BP in different
age groups of children are necessary.
KEY WORDS: Anatomy, Brachial plexus, Newborn, Variation