RAMES MATTAR JUNIOR

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Lattes
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Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 0 Citação(ões) na Scopus
    Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves
    (2024) SIMAO, Danielle Tiemi; HEISE, Carlos O.; RODRIGUES, Joao C.; YAMAUTI, Lucas S.; VILLEGAS, Robin I.; CHO, Alvaro B.; MATTAR JUNIOR, Rames
    IntroductionThe main innervation of the trapezius muscle is provided by the spinal accessory nerve. Several studies describe the contributions of cervical plexus roots to the trapezius muscle innervation, either directly or through connections with the spinal accessory nerve. There is no adequate understanding of how the trapezius muscle is affected after using the spinal accessory nerve in nerve transfer procedures with the usual technique, preserving at least 1 branch for the upper trapezius.MethodsWe evaluated 20 patients with sequelae of traumatic brachial plexus injury who underwent surgical procedures for brachial plexus repair or free muscle transfer, which included the spinal accessory nerve transfer technique and were followed for a minimum of 1 year. The three portions trapezius muscle were evaluated by physical examination, magnetic resonance imaging (analysis of fatty degeneration) and electromyography.ResultsIn all evaluation methods, the middle and lower portions of the trapezius muscle showed more significant morphological and/or functional impairment than the upper portion, in most cases. There was a statistically significant difference in all the complementary exams results, between the affected side (with sacrifice of the nerve) versus the normal side, in the middle and lower portions of the trapezius muscle.ConclusionsPhysical examination alone is not sufficient to determine the residual functionality of the trapezius muscle. Magnetic resonance imaging and electromyography are useful tools to assess both morphological involvement of the trapezius muscle and nerve conduction impairment of the trapezius muscle, respectively. The results suggest that the middle and lower portions of the trapezius muscle are affected by previous SAN transfer and should be considered with caution for further muscle transfer procedures.
  • article 0 Citação(ões) na Scopus
    Atypical Cleft Hand: Surgical Technique for Grasping Improvement
    (2024) BISNETO, Edgard de Novaes Franca; FERNANDES, Laura Filippini Lorimier; PAULA, Emygdio Jose Leomil de; MATTAR JUNIOR, Rames
    Introduction:We present 6 cases of children with atypical cleft hand and discuss a surgical technique. Clinically, participants presented with a lack of pulp-to-pulp pinch due to metacarpophalangeal ligament insufficiency and difficulty grasping large objects because of the narrowed first web.Materials and Methods:Second metacarpal resection and Z-plasty, creating a wide first web. The second extensor digitorum communis tendon was transferred to improve the thumb metacarpophalangeal joint stability.Conclusions:The surgical technique presented in this paper did improve function in oligodactyly or type-IIA atypical cleft hand.