Biomedical subjects

G R Brunelli

Publications and source records attributed to G R Brunelli.

24 records · Page 2Linked to original sources

PubMed1992

Combined second toe and partial nail transfer from the big toe by means of an exteriorized pedicle.

The hand of a three-year old girl was reconstructed by means of a bilateral second toe transplantation following traumatic amputation of all five digits. In a second operation, aimed at reconstructing the index finger, the nail apparatus of the big toe was transferred to the thumb as an "island flap" based on a pedicle from the second toe. The thumb was subsequently lengthened enabling a three-fingered hand to be obtained with only minimal functional impairment of the feet. The authors suggest an original technique allowing transfer of the second toe and of the big toe nail in only one operative stage. The technique of leaving the pedicle exteriorized during transplantation (autonomization) facilitates positioning of the nail onto the recipient site and eliminates subsequent problems of commissural retraction.

Amputation, Traumatic↗

PubMed1992

A fourth type of brachial plexus injury: middle lesion (C7).

The authors describe a fourth type of traumatic brachial plexus lesion which was found in 11% of injuries to the spinal nerve roots, trunks and cords. This lesion consists of isolated or predominant lesion of the middle elements. While high lesions are caused by shoulder trauma in a downward direction and low lesions by trauma in abduction, middle lesions are produced by trauma in an anteroposterior direction. The high incidence of this type of lesion led the authors to propose the following new classification: high lesions (C5, C6)(Duchenne-Erb); middle lesions (C7); low lesions (C8, T1) (Dejerine-Klumpke); complete lesions.

Brachial Plexus↗

PubMed1992

Reconstruction of traumatic absence of the thumb in the adult by pollicization.

Amputation of the thumb is a severe handicap. In an emergency situation, thumb amputation must be treated by means of reimplantation when possible. If reimplantation cannot be performed or fails, several methods of thumb reconstruction can be used according to various factors. These include the number of surviving fingers and the level of the thumb amputation. Pollicization is the first choice for amputations proximal to the metacarpophalangeal joint when four and even three fingers are present. It is the easiest and safest operation that supplies the best results both from the motor and sensory points of view. Pollicization can be done even in an emergency situation in selected patients. The index finger is preferred because it can be pollicized without palmar scar or tendons, vessels, or nerves crossing over. If a damaged finger is present, it is preferred to the index finger to leave one more sound finger; a damaged finger can frequently be used, because the thumb is shorter than the other fingers, and although its mobility is very important at the trapeziometacarpal joint, it is less important at the metacarpophalangeal and interphalangeal joint levels. It is preferable to take as much second metacarpal bone as necessary to place the transferred second metacarpophalangeal joint at the position of the thumb metacarpophalangeal joint so that the tendons of the index interosseous muscles can be sutured to the intrinsic muscles of the thumb. According to this concept, the distal phalanx of the transferred finger should be amputated. In this manner, the new thumb will have a normal size, only two phalanges, only one extrinsic flexor, and normal insertion of the muscles of the thumb.

Adult↗

PubMed1991

A fourth type of brachial plexus lesion: the intermediate (C7) palsy.

A new type of brachial plexus lesion has been defined to be added to the classical types, i.e. the upper (Duchenne Erb), the lower (Dejerine Klumpke) and the total type. This new type is the intermediate palsy. The lesion is a partial involvement of the plexus, the predominant lesion of which involves C7 with a variable involvement of the upper or lower plexus. By observations during operation, and in cadavers, three different mechanisms are considered responsible for the three different types of lesion. A trauma with downwards traction principally involves the upper plexus. Trauma in abduction first involves the lower plexus while a traumatic force acting from an anterior to a posterior direction involves firstly and predominantly the C7 spinal nerve which in an anterior position and less oblique than the other roots. Avulsion from the cord or rupture are possible. 33 cases have been observed.

Brachial Plexus↗

PubMed1991

A personal technique for treatment of scaphoid non-union.

We describe a personal technique for the treatment of scaphoid non-union, consisting of styloidectomy of the radius associated with axial perforation of the scaphoid, emptying of the bone, filling it again by cancellous bone taken from the styloid and securing it with a peg obtained from the cortex of the same styloid. 52 patients out of 77 operated on with this technique were reviewed. Results are shown and seem to be better than those found in literature.

Adolescent↗

PubMed1991

Anatomical study of distal insertion of the abductor pollicis longus. Concept of a new musculo-tendinous unit: the abductor carpi muscle.

Having performed 100 anatomical dissections we found that in the first dorsal compartment of the wrist besides other tendons there are one or two tendons belonging to a musculo-tendinous unit, not yet described, inserting in the trapezium and acting almost together with the other units going to the first metacarpal. This is present in 71% of cases. Its function is to abduct the carpus. Therefore we suggest to call this unit the "abductor carpi" muscle. If it is missing, which is "abnormal", instability and arthritis of the trapezio-metacarpal joint occur in a higher percentage because the other abducent forces pull the base of the first metacarpal with a shearing effect on the TM joint. Besides other less frequent variants, other "anomalies" such as the presence of a tendon going to the abductor pollicis brevis (59%) or to the opponents muscle (15%) have been found.

Carpal Bones↗