ALVARO BAIK CHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
15 resultados
Resultados de Busca
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- Shoulder Arthrodesis for Traumatic Brachial Plexus Injuries: Functional Outcomes and Complications(2023) CHO, Alvaro Baik; CHOI, Helio Jiseok; FERREIRA, Carlos Henrique Vieira; KIYOHARA, Leandro Yoshinobu; SILVA, Gustavo Bersani; SORRENTI, LuizBackgroundThe external rotation and abduction of shoulder are considered one of the priorities of reconstruction in brachial plexus injury. The aim of this study was to evaluate the functional results and complications of shoulder arthrodesis in patients with brachial plexus injury to better comprehend the benefits of this procedure.MethodsBetween 2015 and 2019, 15 shoulder arthrodesis were performed in patients with long-standing brachial plexus injury. The main indication for arthrodesis was absent or poor recovery of shoulder abduction and external rotation. Patients presented different levels of injury. Shoulder measurements of active abduction and external rotation were made based on image records of the patients. A long 4.5-mm reconstruction plate was fit along the scapular spine, acromion, and lateral proximal third of the humerus. Structured bone graft was fit into the subacromial space.ResultsThe mean preoperative abduction was 16 degrees, and the mean postoperative abduction was 42 degrees. The mean preoperative external rotation was -59 degrees, and the mean postoperative external rotation was -13 degrees. The mean increase in abduction and external rotation was 25 degrees and 45 degrees, respectively. Bone union was achieved in all cases at an average time of 5.23 months. We experienced humeral fractures in 26.66% of the cases, which were all successfully treated nonoperatively.ConclusionsShoulder arthrodesis is a rewarding procedure for patients with brachial plexus injuries. A marked improvement in the upper limb positioning was observed in all patients. It should be considered as the main therapeutic option in cases where nerve reconstruction is no longer possible.
- Do two venous anastomoses decrease venous thrombosis during limb reconstruction?(2019) IAMAGUCHI, Raquel; BURGOS, Felipe; SILVA, Gustavo; CHO, Alvaro; NAKAMOTO, Hugo; TAKEMURA, Renan; WEI, Teng; REZENDE, Marcelo de; JR, Rames MattarBACKGROUND: The optimal number of veins to be anastomosed in perforator flaps for limb reconstruction and its influence on the results remain controversial. Venous thrombosis of microvascular anastomoses is a commonly recorded complication in soft tissue reconstruction. OBJECTIVE: To evaluate the effect of two venous anastomoses in the incidence of venous thrombosis for limb reconstruction using anterolateral thigh (ALT) microsurgical free flaps. METHODS: This was a cross-sectional study on patients undergoing limb reconstruction using ALT flap during 2014-2017. Perioperative information was recorded and patients were divided in two groups: group 1 (one venous anastomosis; 17 patients) and group 2 (two venous anastomoses; 21 patients). Complications were investigated. RESULTS: Overall, 38 microsurgical flaps were included. The mean age was 33 years, and 32 patients were male. The most prevalent wounds were traumatic. Group 1 presented a higher complication rate than group 2 (47% vs. 24%; p = 0.065), although the difference was not significant. Group 1 presented a higher rate of venous anastomotic thrombosis (p = 0.032) than group 2. The overall success rate was 92%. CONCLUSION: For limb reconstruction using ALT microsurgical free flaps, two venous anastomoses are associated with a low rate of venous thrombosis in microvascular anastomoses.
- Comparison between donor nerves to motorize the free functional gracilis muscle transfer for elbow flexion: Retrospective study of 38 consecutive cases in traumatic adult brachial plexus injuries(2019) CHO, Alvaro B.; SILVA, Gustavo Bersani; PISANI, Marina J.; ALVES, Jairo A.; IAMAGUCHI, Raquel B.; WEI, Teng H.; REZENDE, Marcelo R. dePurpose Elbow flexion deficit is a frequent problem in traumatic brachial plexus injuries and reestablishment of this function is the primary treatment goal. When management is delayed, or the initial acute approach fails, free functional transfer of the gracilis muscle for elbow flexion is the treatment of choice. In this report, the authors present the results of a comparison study on different donor nerves (spinal accessory and ulnar) in elbow flexion reconstruction with gracilis flap for traumatic adult brachial plexus injuries. Methods Retrospective analysis of patients with both total or partial traumatic brachial plexus injuries was carried out. Of the 38 patients enrolled, 37 were male (97.4%) with a mean age of 28.3 years. The mean follow-up period was 25 months. Postoperative function of the gracilis muscle flap was recorded and patients were divided into two groups according to donor nerve: spinal accessory nerve (SAN) (18 cases), and motor fascicles of the ulnar (ULNAR) (20 cases). Results Twenty-six cases obtained elbow flexion strength M3 or M4 (68.4%): 0 M0 (0.0%), 4 M1 (10.5%), 8 M2 (21.1%), 9 M3 (23.7%) and 17 M4 (44.7%). The mean interval to first recorded M3 muscular strength was 12.4 months. Functional elbow flexion strength (>= M3) had the following distribution: SAN 83.3% (15/18) and ULNAR 55.0% (11/20) (p = .086). Conclusion No statistical difference for final muscle strength was found between donor nerve groups.
- Biomechanical comparison of the four-strand cruciate and Strickland techniques in animal tendons(2013) IAMAGUCHI, Raquel Bernardelli; VILLANI, William; REZENDE, Marcelo Rosa; WEI, Teng Hsiang; CHO, Alvaro B.; SANTOS, Gustavo Bispo dos; MATTAR JR., RamesOBJECTIVE: The objective of this study was to compare two four-strand techniques: the traditional Strickland and cruciate techniques. METHODS: Thirty-eight Achilles tendons were removed from 19 rabbits and were assigned to two groups based on suture technique (Group 1, Strickland suture; Group 2, cruciate repair). The sutured tendons were subjected to constant progressive distraction using a universal testing machine (Kratos (R)). Based on data from the instrument, which were synchronized with the visualized gap at the suture site and at the time of suture rupture, the following data were obtained: maximum load to rupture, maximum deformation or gap, time elapsed until failure, and stiffness. RESULTS: In the statistical analysis, the data were parametric and unpaired, and by Kolmogorov-Smirnov test, the sample distribution was normal. By Student's t-test, there was no significant difference in any of the data: the cruciate repair sutures had slightly better mean stiffness, and the Strickland sutures had longer time-elapsed suture ruptures and higher average maximum deformation. CONCLUSIONS: The cruciate and Strickland techniques for flexor tendon sutures have similar mechanical characteristics in vitro.
- Do technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury?(2021) MARTINS-FILHO, Francisco Vilmar Felix; IWASE, Fernanda do Carmo; SILVA, Gustavo Bersani; CHO, Alvaro Baik; WEI, Teng Hsiang; REZENDE, Marcelo Rosa de; JR, Rames Mattar; IAMAGUCHI, Raquel BernardelliIntroduction: The traumatic lesions of the brachial plexus in adults are devastating injuries causing continuous severe functional impairment for both work and daily living activities. The restoration of elbow flexion is one of the most important movements for patient recovery to previous activities. Free gracilis muscle transfer has good outcomes for cases with late presentation or as a rescue surgery to regain elbow flexion, however, bad results are present in all cohorts with insufficient recovery of muscle strength for elbow flexion. A number of hypotheses can be postulate to explain the fair results observed in some cases of free gracilis muscle transfer for elbow flexion. Most studies in the current literature compare the choice of the donor nerve used in neurotization and nerve grafts. The aim of this study is to evaluate if technical components of microvascular anastomosis could influence the functional outcome of free functional muscle transfer for elbow flexion in adult patients with traumatic brachial plexus injury. Material and methods: Included all adult patients with traumatic brachial plexus injury submitted to free functional gracilis muscle transfer for elbow flexion. The complications and functional results according to British Medical Research Council (BMRC) score were recorded. Results: We assessed 26 patients with mean age of 32.8 years. The most common donor nerve for gracilis muscle was the accessory nerve in 18 patients. Eighteen patients presented with good result (M3/M4). The mean ischemia time was higher for patients with bad results (132 minutes) comparing with patients with good results (122 minutes). Patients with only one venous anastomosis had 41% of poor functional outcome compared with 22% of cases with two venous anastomoses. No statistically significant difference in the ischemia time of the cases with good or poor functional outcome was observed (p = 0.657), as for the number of venous anastomoses (p = 0.418). Conclusion: Our study observes that patients with only one venous anastomoses for drainage of free gracilis and those with longer intraoperative ischemia time had higher incidence of poor functional outcome of free gracilis muscle transfer for elbow flexion, but not statistically significant. Level of proof: II; prospective cross-sectional study.
- 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, RamesIntroductionThe 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.
- Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?(2021) MACEDO, Lucas Sousa; RUSIG, Renato Polese; SILVA, Gustavo Bersani; CHO, Alvaro Baik; WEI, Teng Hsiang; IAMAGUCHI, Raquel BernardelliBACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA-). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.
- INTERCOSTAL NERVE TRANSFER TO THE BICEPS MOTOR BRANCH IN COMPLETE TRAUMATIC BRACHIAL PLEXUS INJURIES(2015) BAIK, Alvaro; IAMAGUCHI, Raquel Bernardelli; SILVA, Gustavo Bersani; PAULOS, Renata Gregorio; KIYOHARA, Leandro Yoshinobu; SORRENTI, Luiz; MENEZES, Klicia de Oliveira Costa Riker Teles de; REZENDE, Marcelo Rosa de; WEI, Teng Hsiang; MATTAR JUNIOR, RamesThe purpose of this report is to critically evaluate our results of two intercostal nerve transfers directly to the biceps motor branch in complete traumatic brachial plexus injuries. From January 2007 to November 2012, 19 patients were submitted to this type of surgery, but only 15 of them had a follow-up for >= 2 years and were included in this report. The mean interval from trauma to surgery was 6.88 months (ranging from 3 to 9 months). Two intercostals nerves were dissected and transferred directly to the biceps motor branch. The mean follow-up was 38.06 months (ranging from 24 to 62 months). Ten patients (66.6%) recovered an elbow flexion strength >= M3. Four of them (26.66%) recovered a stronger elbow flexion >= M4. One patient (6.25%) recovered an M2 elbow flexion and four patients (26.66%) did not regain any movement. We concluded that two intercostal nerve transfers to the biceps motor branch is a procedure with moderate results regarding elbow flexion recovery, but it is still one of the few options available in complete brachial plexus injuries, especially in five roots avulsion scenario. (C) 2015 Wiley Periodicals, Inc.
- A REINFORCEMENT OF THE SUTURED MICROVASCULAR ANASTOMOSIS WITH FIBRIN GLUE APPLICATION: A RETROSPECTIVE COMPARATIVE STUDY WITH THE STANDARD CONVENTIONAL TECHNIQUE(2017) CHO, Alvaro Baik; PAULOS, Renata Gregorio; BERSANI, Gustavo; IAMAGUCHI, Raquel Bernardelli; TORRES, Luciano Ruiz; WEI, Teng Hsiang; RESENDE, Marcelo Rosa De; MATTAR JUNIOR, RamesPurpose: Although a reasonable number of studies report satisfactory results with fibrin glue application in microvascular anastomosis since 1977, its utilization in the clinical setting has being scant in the literature. The aim of this study was to report the cumulated experience with the fibrin glue in free flaps over a period of 10 years, comparing the survival rate with the standard sutured anastomosis. Patients and methods: From August 2001 through November 2014, 83 consecutive free flaps were performed by a team of surgeons from two hospitals. About 56 flaps were performed in 56 patients using the fibrin glue augmented microvascular anastomosis and 27 flaps were performed in 27 patients using the conventional anastomosis technique. The decision on whether or not the fibrin glue should be used at the anastomoses was based on its availability and whose surgeon was performing the anastomoses. About approximately 60% of sutures stitches were used that would be used in a conventional anastomosis, when fibrin glue application was anticipated (ranging from 5 to 7 sutures in the arteries and 5 to 8 in the veins). Results: The overall survival rate of the flaps performed with fibrin glue application was 92.85%. In one case, a revision of the venous anastomosis was required due to early flap congestion. Four cases (7.14%) had failure of the first free flap and two of them were submitted to another free flap without fibrin glue application. In the flaps performed with the conventional anastomosis technique the survival rate was 92.59%. This difference was not statistically significant (P=0.97). Conclusion: The application of fibrin glue in microvascular anastomoses did not increase the rate of flap loss and had a potential to reduce the number of sutures required to complete an anastomosis by its sealing effect. (C) 2016 Wiley Periodicals, Inc.
- Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration(2021) REZENDE, Marcelo R. De; VERONESI, Bruno A.; PAULOS, Renata G.; CHO, Alvaro B.; RIBAK, Samuel; JUNIOR, Rames M.Purpose In upper and chronic brachial plexus injuries for which neurological surgery is not a good treatment option, one possibility for gaining elbow flexion is free functional muscle transfer. The primary aim of our study was to evaluate the elbow flexion gain achieved by free gracilis muscle transfer with partial ulnar nerve neurotization. Methods This surgery was performed in 21 patients with upper and chronic (> 12 months) brachial plexus injuries. The level of injury, patient age, the time between trauma and surgery, the affected side, and the aetiology of the lesion were recorded. The primary outcome evaluated was elbow flexion muscle strength, which was measured using the British Medical Research Council (BMRC) scale, in patients with a minimum follow-up period of 12 months. The criterion used to classify elbow flexion as good was a grade of M4 or higher. Results An M4 elbow flexion strength gain was observed in 61.9% of the patients. A gain of M2 or higher was observed in 95.2% of the patients. The mean range of active motion was 77 degrees (range 10 minimum-110 maximum). Conclusion In patients with upper and chronic brachial plexus injuries, free gracilis muscle transfer with ulnar nerve neurotization yields a satisfactory gain in elbow flexion strength and is therefore a good treatment option.