Kazuteru Doi

Ogori Daiichi General Hospital · Department of Orthopedic Surgery


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    ABSTRACT: Hopkins syndrome is a rare cause of poliomyelitis-like paralysis affecting 1 or more extremities after an acute attack of asthma. The exact etiology of Hopkins syndrome is not known. A 4-year-old girl developed acute asthma followed by complete flaccid paralysis of the left upper extremity. She underwent staged reconstruction using the double free muscle transfer technique. Rigorous postoperative physiotherapy was carried out to achieve a good functional outcome. At recent follow-up, 27 months after the first procedure, the patient was able to effectively use the reconstructed hand for most daily activities. She had good control and could perform 2-handed activities. The selection of a suitable operative treatment and suitable donor nerves is critical, and there are no clear guidelines in the literature. The double free muscle transfer can be effectively employed in similar cases to restore grasping function.
    The Journal of hand surgery 02/2014; 39(2):312-316. · 1.33 Impact Factor
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    ABSTRACT: Radiation-induced brachial plexopathy is a delayed complication of radiation treatment for tumors involving the neck and chest area and is progressive. A 56-year-old woman presented to us with loss of elbow flexion and weak wrist and finger extension 15 years after she received external beam radiation to the left chest, axilla, and supraclavicular region for treatment of breast cancer. She was managed with a gracilis free muscle transfer for elbow flexion and hand prehension. By 2 years after surgery she regained elbow range of motion of 40° to 110° and improved in hand function. She was able to perform activities of daily living. Disabilities of the Arm, Shoulder, and Hand score improved from 56 to 20.
    The Journal of Hand Surgery. 01/2014;
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    ABSTRACT: Vascular trauma associated with brachial plexus injury affects the selection of reconstructive procedures. Often, there is a paucity of appropriate recipient vessels with adequate blood flow for functioning free muscle transfer. The presence of associated vascular injuries of the subclavian or axillary artery is considered a contraindication to the double free muscle technique. The authors hypothesized that vascular repair of subclavian or axillary artery trauma might not be necessary for successful reconstruction using the double free muscle technique, provided that the recipient arteries for functioning free muscle transfer (e.g., thoracoacromial and thoracodorsal arteries) are found to be patent on preoperative angiography. The authors investigated the pathway of collateral circulation and potential recipient vessels for functioning free muscle transfer reconstruction in 20 brachial plexus injury patients associated with subclavian or axillary artery trauma using multidetector-row computed tomographic angiography. Based on these findings, the authors restored upper extremity function using the double free muscle technique without surgical repair of the injury to the major vessel in three patients. The suprascapular artery was the major stem artery for collateral circulation, and the circumflex scapular and subscapular arteries were major reentry arteries. The authors successfully used the thoracoacromial and thoracodorsal arteries as the recipient vessels for functioning free muscle transfers in the double free muscle technique. The preliminary functional outcomes of all three cases were satisfactory. This study demonstrates the feasibility of double free muscle technique reconstruction in brachial plexus injury patients, without actual vascular repair for the associated subclavian or axillary artery trauma. Therapeutic, IV.
    Plastic and reconstructive surgery 12/2013; 132(6):1504-12. · 2.74 Impact Factor
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    ABSTRACT: Double free muscle transfer for the treatment of traumatic total brachial plexus injury provides useful prehensile function. We studied the outcome of this muscle transfer procedure, including the changes in disability and quality-of-life scores. Thirty-six patients with traumatic total brachial plexus injury who underwent double free muscle transfer for reconstruction from 2002 to 2008 and had a minimum follow-up of twenty-four months after the second free muscle transfer were studied. All were evaluated preoperatively and postoperatively with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) questionnaires. A separate questionnaire was used to determine job status, pain, use of the reconstructed hand, and satisfaction with the procedure. The mean patient age was twenty-nine years (range, sixteen to forty-nine years), and the mean duration of follow-up was thirty-six months (range, twenty-four to seventy-nine months). The mean active range of motion was 23° (range, 0° to 80°) for shoulder flexion, 31° (range, 0° to 90°) for shoulder abduction, -18° (range, -80° to 40°) for shoulder external rotation, 62° (range, 0° to 130°) for the shoulder rotation arc, 119° (range, 90° to 150°) for elbow flexion, and -33° (range, -60° to -20°) for elbow extension. The power of elbow flexion was M4 in twenty-five patients and M3 in eleven. Twenty-three patients had triceps nerve reconstruction; extension was M0 in two of these patients, M1 in seven, M2 in ten, and M3 in four. Total active motion of the fingers was 46° (range, 0° to 98°), with a mean hook grip strength of 4 kg (range, 0 to 12 kg). Wilcoxon tests revealed significant improvements in the DASH score and the SF-36 physical functioning, role physical, and physical component summary scores. The majority of patients worked but had changed their type of work, used the reconstructed hand in activities of daily living that required both hands, and were satisfied with the procedure. Double free muscle transfer yielded satisfactory function and allowed use of the reconstructed hand in activities that required both hands. The improvement in the DASH score was greater than that in the SF-36 score. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 08/2013; 95(16):1505-12. · 3.23 Impact Factor
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    ABSTRACT: Anatomic variations in branching pattern of axillary artery (AxA) are common and typically involve subscapular artery (SsA) and posterior circumflex humeral artery (PCHA). Several skin and muscle flaps are based on the branches of AxA. Furthermore, these branches are frequently used as recipient vessels in functioning free muscle transfers for upper extremity reconstruction and in breast reconstruction. Accurate knowledge of the normal anatomy and variations in branching pattern of AxA is of significant clinical importance for the reconstructive microsurgeon. The purpose of this article is to report the variable branching pattern of AxA based on multidetector-row computed tomography angiography study of 62 upper extremities. The thoracoacromial artery consistently originated from the first or second part of AxA. The classic origin and branching patterns of SsA and PCHA were observed in 21 cases (33.9%). Anatomic variations of SsA and PCHA were observed in 41 upper extremities (66.1%). In addition to the classic pattern, five distinct variations were noted.
    Journal of Reconstructive Microsurgery 07/2013; · 1.00 Impact Factor
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    ABSTRACT: Outcomes of Kanaya's procedure for congenital proximal radioulnar synostosis varied depending on the type of radial head dislocation. In our series of 14 patients with 17 forearms who underwent Kanaya's original procedure, the postoperative total rotation arc of the forearm was unsatisfactory in cases with posterior radial head dislocation. We examined the outcomes with respect to the type of radial head dislocation and radial shaft curvature. Radial shafts with a posterior radial head dislocation had only one curve and the radii of the curve were statistically smaller than those in anterior dislocated or enlocated heads, which had two curves. As a result, we modified the osteotomy site for proximal radioulnar synostosis with posterior radial head dislocation and achieved improved forearm rotation and physiological rotation of the radial head in our latest two cases.
    The Journal of hand surgery, European volume. 07/2013;
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    ABSTRACT: The strategy of limb salvage following surgical resection of skeletal tumor has led to an increased demand for more complex reconstructive options in order to achieve better functional outcomes. Functional neuro-vascularized muscle transfer (FMT) is a beneficial tool for restoring joint movement involving the reconstruction of "movement" in the affected extremity. Until now, however, the clinical application of FMT was mainly limited to trauma cases and to date, very few studies have focused on musculoskeletal oncology. In this study, we reviewed patients who underwent wide resection for extremity sarcoma and functional reconstruction using FMT and discussed the advantages, indications and complications of the procedure.
    Surgical Oncology 07/2012; 21(4):263-8. · 2.14 Impact Factor
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    ABSTRACT: This experiment establishes the principles of using the compound muscle action potential (CMAP) as a possible postoperative monitor for free muscle grafts. Twenty rabbits were divided into two groups of ten each to investigate the effects of ischemia on CMAP of the muscles. Rectus femoris model was used and contralateral muscle was used as control. In all muscles total normothermic ischemia of 1.5 hours to mimic the time needed for transfer and inset of the flap was followed by occlusion of the artery in one group and vein in another group after 3 hours. During this ischemia of 1 hour, the CMAP amplitudes decreased and the latencies were prolonged. Latency prolongation was detected within 10 minutes of total, arterial, or venous ischemia. During the revascularization, both amplitude and latency improved, but not to the original values at the start. The results show that CMAP monitoring can provide easily detectable, objective indication of vascular compromise to a muscle graft within as early as 10 minutes of total, arterial, and venous ischemia. Changes in latency are more constant and predictable compared with amplitude changes. This method can provide continuous monitoring and can be used in buried muscle grafts.
    Journal of Reconstructive Microsurgery 06/2012; 28(6):387-93. · 1.00 Impact Factor
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    ABSTRACT: Full range of motion and powerful shoulder abduction can be performed without any deltoid muscle function by the supplemental action of the supraspinatus and biceps brachii muscles. For evaluation of deltoid muscle function, we need to negate these actions, which can be done with the "akimbo test," in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm. We examined the akimbo test in five patients with incomplete upper-type brachial plexus injury, five patients with suprascapular nerve palsy, and six patients with axillary nerve palsy. Presence of some abduction is a prerequisite to perform this test. No patient with incomplete upper-type brachial plexus injury could demonstrate this sign when the deltoid did not show a certain level of the power to abduct the shoulder joint. All patients with suprascapular nerve could demonstrate this sign as the deltoid was normal. No patient with axillary nerve paralysis could demonstrate this sign. The akimbo test is a simple clinical test to determine deltoid muscle paralysis or dysfunction, especially when patients can demonstrate shoulder abduction due to supplementary action of other muscles.
    Journal of Reconstructive Microsurgery 05/2012; 28(6):375-9. · 1.00 Impact Factor
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    ABSTRACT: Skin loss, need for vein grafts, and secondary surgeries are often encountered in avulsion injuries of the thumb. We report a case of successful salvage of an avulsion type of near total amputation of the thumb following a conveyor belt injury in which the first dorsal metacarpal artery adiposofascial flap was used for combined soft tissue cover and venous conduit.
    Journal of Reconstructive Microsurgery 04/2012; 28(5):297-300. · 1.00 Impact Factor
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    ABSTRACT: Conventional skin flap monitoring is one of the widely used methods to assess postoperative circulation in innervated free muscle transfer (IFMT). However, following reexploration for vascular compromise and reestablishing circulation, functional recovery of the muscle despite surviving skin flap is not clear. The purpose of this article is to report three such cases and determine the reliability of viable skin flap in an IFMT with a second ischemic event. Long-term functional results were assessed in terms of reinnervation time, elbow range of motion, strength of elbow flexion, finger function in terms of total active motion, and power lifting with hook grip. These IFMTs developed complete or partial necrosis of the muscle and could not obtain satisfactory function. The conventional monitoring of the skin flap did not promptly reflect vascularity of IFMT, and a surviving skin flap after reexploration for compromised vascularity does not guarantee complete survival of the muscle. There is a need for earlier and rapid detection of vascular compromise in IFMTs.
    Journal of Reconstructive Microsurgery 04/2012; 28(4):267-71. · 1.00 Impact Factor
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    ABSTRACT: Free gracilis transfers are done for reanimation of the upper limb in traumatic total brachial plexus palsy. Because of buried nature of the free muscle and monitoring skin flap in the axillary or infraclavicular region, it is always a tricky situation for continuous and repeated monitoring to assess vascular status. Critical ischemia times vary between the muscle and monitoring skin flap because of which signs of ischemic changes in the monitoring skin flap are always delayed with respect to the muscle. We describe a novel method that uses the principle of evoked potentials from the muscle to assess the vascular status of the free muscle and detects vascular compromise early before the skin changes are apparent.
    Techniques in hand & upper extremity surgery 03/2012; 16(1):48-51.
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    ABSTRACT: We report an unusual case of proximal interphalangeal joint locking of the ring finger due to the neglected flexor digitorum profundus avulsion. Although rare, it should be noted that locking is a potential complication after this injury.
    Hand Surgery 01/2012; 17(1):115-6.
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    ABSTRACT: Calcium pyrophosphate dihydrate deposition disease typically involves the wrist joint in the form of calcifications of the triangular fibrocartilage and the distal radioulnar joint. We describe an 87-year-old male who presented to us with asymptomatic form of deposition with multiple flexor tendon calcifications causing chronic median nerve compression. Simple carpal tunnel decompression relieved his median nerve symptoms.
    Hand Surgery 01/2012; 17(1):89-92.
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    ABSTRACT: We reviewed 18 patients who had received double free muscle transfers and wrist arthrodesis to determine the effect of the stiff wrist on digital motion and function. The patients were 15 men and 3 women with a mean age of 24 years. We determined the total active motion of the metacarpophalangeal and interphalangeal joints just before performing the arthrodesis and at final follow-up. We recorded the Disabilities of the Arm, Shoulder, and Hand functional score at the same times. All of our patients showed evidence of fusion at a mean of 12 ± 2 weeks (range, 10-15 wk). The digital mean total active motion was 39° ± 21° before arthrodesis and 49° ± 25° after arthrodesis. Preoperative Disabilities of the Arm, Shoulder, and Hand scores significantly decreased after fusion. Three cases were complicated postoperatively by wound hematoma. Five patients required wrist arthrodesis hardware removal because of skin irritation. Wrist fusion in patients receiving double free muscle transfers resulted in improved finger range of motion and overall hand function. Therapeutic IV.
    The Journal of hand surgery 11/2011; 37(2):277-81. · 1.33 Impact Factor
  • The Journal of Bone and Joint Surgery 09/2011; 93(18):e105. · 3.23 Impact Factor
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    ABSTRACT: Debridement arthroplasty combined with capsulectomy for primary osteoarthritis of the elbow is a useful procedure to relieve pain and increase mobility. We have used a medial trans-flexor approach without tendon detachment for debridement arthroplasty of the elbow and evaluated the outcome of this procedure. Thirty-one elbows with primary osteoarthritis in 31 patients treated with debridement arthroplasty were available for follow-up at a mean of 19 ± 7 months. Twenty-four patients were men, and 7 were women. The mean age at the time of surgery was 59 ± 10 years. All elbows were painful only at the end points of motion. The anterior compartment of the elbow was accessed by splitting of the pronator flexor muscle group without tendon detachment. Routine anterior subcutaneous transposition of the ulnar nerve was used in all elbows. In 10 elbows, osteophytes or loose osseous bodies from the lateral compartment were removed through an additional lateral approach. Twenty-three elbows had no pain, and 8 elbows had mild pain. The mean preoperative limitation of extension decreased from 29° ± 9° to 15° ± 9° and the mean preoperative flexion increased from 100° ± 10° to 126° ± 7°. Thus, the mean arc of elbow motion increased by 40° ± 13°. The mean Mayo Elbow Performance Score was 94 ± 7 compared with 60 ± 5 before surgery. The results were excellent for 22 elbows and good for 9. Hematomas developed in 3 elbows, but they did not require surgical drainage. Debridement arthroplasty using the medial trans-flexor approach without tendon detachment yields satisfactory short-term clinical results. This approach is associated with a low rate of complications and is safe and effective for the treatment of primary osteoarthritis of the elbow. Therapeutic IV.
    The Journal of hand surgery 08/2011; 36(10):1652-8. · 1.33 Impact Factor
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    ABSTRACT: C5-7 brachial plexus preganglionic injuries are usually associated with complete paralysis of the long thoracic nerve. This makes it difficult to provide satisfactory shoulder function by neurotizing only the suprascapular nerve, compared with C5 and C6 preganglionic injuries, in which the long thoracic nerve is spared. We present a case report of a 21-year-old man who sustained a C5-7 brachial plexus preganglionic injury and obtained excellent shoulder function by intercostal nerve transfer to the long thoracic nerve in addition to neurotization of the suprascapular nerve. Our report emphasizes the importance of restoring the activity of the long thoracic nerve.
    The Journal of hand surgery 09/2010; 35(9):1427-31. · 1.33 Impact Factor
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    ABSTRACT: We describe our surgical technique for harvesting the free vascularized superficial radial nerve graft based on the radial artery and its venae comitantes. Anatomy and preoperative preparation are also presented, as well as the indications and some contraindications.
    The Journal of hand surgery 02/2010; 35(2):312-5. · 1.33 Impact Factor
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    ABSTRACT: We present a rare case of attritional rupture of the flexor tendons to the small finger caused by an osteophyte of the volar aspect of the ulnar head.
    The Journal of hand surgery 01/2010; 35(1):24-6. · 1.33 Impact Factor

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