Browsing by Author "Gross, Jeffrey N."

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    Outcomes after Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer
    (Thieme, 2023-01-11) Gross, Jeffrey N.; Dawson, Steven E.; Wu, Gerald J.; Loewenstein, Scott; Borschel, Gregory H.; Adkinson, Joshua M.; Surgery, School of Medicine
    Background: Ulnar nerve lesions proximal to the elbow can result in loss of intrinsic muscle function of the hand. The anterior interosseous nerve (AIN) to deep motor branch of the ulnar nerve (DBUN) transfer has been demonstrated to provide intrinsic muscle reinnervation, thereby preventing clawing and improving pinch and grip strength. The purpose of this study was to evaluate the efficacy of the AIN to DBUN transfer in restoring intrinsic muscle function for patients with traumatic ulnar nerve lesions. Methods: We performed a prospective, multi-institutional study of outcomes following AIN to DBUN transfer for high ulnar nerve injuries. Twelve patients were identified, nine of which were enrolled in the study. The mean time from injury to surgery was 15 weeks. Results: At final follow-up (mean postoperative follow-up 18 months + 15.5), clawing was observed in all nine patients with metacarpophalangeal joint hyperextension of the ring finger averaging 8.9 degrees (+ 10.8) and small finger averaging 14.6 degrees (+ 12.5). Grip strength of the affected hand was 27% of the unaffected extremity. Pinch strength of the affected hand was 29% of the unaffected extremity. None of our patients experienced claw prevention after either end-to-end ( n  = 4) or end-to-side ( n  = 5) AIN to DBUN transfer. Conclusion: We conclude that, in traumatic high ulnar nerve injuries, the AIN to DBUN transfer does not provide adequate intrinsic muscle reinnervation to prevent clawing and normalize grip and pinch strength.
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    The Safety of Wide-Awake, Local Anesthesia, No Tourniquet Hand Surgery: Two Cases of Digital Ischemia
    (Wolters Kluwer, 2020-10-09) Cook, Julia Anne; Donato, Daniel P.; Gross, Jeffrey N.; Gerety, Patrick A.; Sasor, Sarah E.; Medicine, School of Medicine
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    Supraclavicular Approach to the Brachial Plexus
    (Wolters Kluwer, 2023-01-23) Dawson, Steven E.; Gross, Jeffrey N.; Berns, Jessica M.; Weinzerl, Thomas; Adkinson, Joshua M.; Borschel, Gregory H.; Surgery, School of Medicine
    Background: The brachial plexus consists of an intricate array of nerves originating from the C5–T1 ventral rami of the spinal cord. Their course is complex and can be substantially distorted after injury. Thus, dissection of the brachial plexus can be difficult. Here, we present a practical approach to the supraclavicular dissection of the brachial plexus, with emphasis on relevant anatomy and surgical landmarks. Methods: This anatomical review was prepared using intraoperative surgical imaging. In addition, illustrations are used to display the images in schematic form. We present a stepwise surgical approach to the supraclavicular dissection of the brachial plexus. We highlight the differences between pre- and postganglionic nerve root injuries, and also relevant anatomical variants of the brachial plexus. Results: Eleven steps are recommended to facilitate the supraclavicular approach to the brachial plexus. Conclusion: The supraclavicular dissection of the brachial plexus is reliable with consistent landmarks and can be carried out in a stepwise fashion.
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    Surgical Management of Sirenomelia: A Case Study
    (Wolters Kluwer, 2023-09-15) Bhagat, Neel D.; Patel, Aadarsh; Gross, Jeffrey N.; Borschel, Gregory H.; Surgery, School of Medicine
    Background: Sirenomelia is a rare congenital condition characterized by fusion of the lower limbs. Patients with sirenomelia generally do not survive long after birth because the condition is associated with multisystem organ dysfunction due to developmental anomalies. Considering the low incidence and few cases surviving the neonatal period, there is minimal understanding regarding the surgical management of sirenomelia. We present a unique case of an infant born with type 1 sirenomelia, absence of external genitalia, presence of a cloaca, absence of the bladder, and presence of an imperforate and vestigial anus, who not only survived the birth process, but, at the age of 11 months, was determined to be a candidate for surgical separation of the lower extremities. Methods: This case was approached much like a dorsal rectangular flap syndactyly release. Large Z-plasty flaps were designed and raised, and the soft tissue within the skin bridge was meticulously dissected to preserve anatomy and to provide adequate skin flaps without perineal skin grafting. A quadrangular flap was designed to reconstruct the perineum and produce a neo-vulva using de-epithelialization. Results: Successful lower extremity separation was achieved. There were no major postoperative complications. The patient progressed with lower extremity function, and eventually achieved independent ambulation. Conclusions: Management of sirenomelia is incredibly challenging, and data to guide surgical management are limited. This report details our approach to a successful lower extremity separation, repair, and neo-vulvar reconstruction in a case of type I sirenomelia.