TENG HSIANG WEI
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
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
8 resultados
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- 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.
- 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.
- Detecção de trombose venosa em retalhos livres por medidas de glicemia capilar(2012) MILLAN, Lincoln Saito; ISHIDA, Luiz Carlos; CHOI, Esther Mihwa Oh; GIACCHETTO JUNIOR, Enio Cesar; WEI, Teng Hsiang; MATTAR JÚNIOR, Rames; FERREIRA, Marcus CastroBACKGROUND: Monitoring of free flaps after surgery is vitally important, especially in the first few hours because the timing of reoperation can determine flap salvage or loss. To date, no study has examined the decision to reoperate on a flap based on the objective measure of glycemia or a comparison between flaps that showed good outcomes and those that showed vascular damage. The objective of this study was to evaluate the validity of blood glucose measurements within the flap as a method for monitoring free flaps and to compare the efficacy of this method with that of clinical assessments. METHODS: The study was prospective, included 16 patients with free flaps, and was conducted from May 2012 to July 2012. A team of professionals not involved in the surgery evaluated capillary glycemia. Flaps were clinically evaluated during the immediate postoperative period, on ICU admission, at every 3 hours, and as needed. RESULTS: Of the 16 patients, 5 (31.3%) had venous thrombosis in the first 24 hours. Statistically significant differences were noted in capillary glycemia in patients with or without venous thrombosis in measurements obtained 6, 9, and 12 hours after surgery (P < 0.05). CONCLUSIONS: The measurement of capillary glycemia was not superior to clinical evaluation by an experienced professional for the detection of venous thrombosis within free flaps.
- 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.
- Reconstrução tardia na mão traumatizada com perda de múltiplos dedos(2017) TAKEMURA, RENAN LYUJI; NAKAMOTO, HUGO ALBERTO; IWASE, FERNANDA DO CARMO; NAKAMOTO, JOÃO CARLOS; VERONESI, BRUNO AZEVEDO; WEI, TENG HSIANGABSTRACT Mutilating hand injuries are a challenge to both the hand surgeon and the patient. The surgeon must make decisions ranging from the initial debridement to which fingers and joints will be preserved and the appropriate use of the parts to be removed. Late reconstruction constitutes the second part of this difficult task. The difficulty attributed to the characteristics of each lesion, the large number of treatment possibilities, and the different levels of complexity must be adapted to the personal needs and motivation of each patient. This case report describes a late hand reconstruction with index and middle finger loss, using metacarpophalangeal joint transplantation of the index finger to gain the proximal interphalangeal function of the middle finger.
- Histological Compatibility in Distal Neurotizations: A Systematic Review(2023) CAVALHEIRO, Cristina Schmitt; NAKAMOTO, Joao Carlos; WEI, Teng Hsiang; SORRENTI, Luiz; WATAYA, Erick YoshioConsidering the importance of defining the minimum number of axons between recipient and donor branches, that is, the definition of histological compatibility in distal neurotizations for the success of the procedure and the surgeon's freedom to choose individualized strategies for each patient, this systematic review was conducted to find out the most recent studies on the subject. The objective of this systematic review was to determine the importance of the number of axons and the relationship between axon counts in the donor and recipient nerves in the success of nerve transfer. A literature review was performed on five international databases: Web of Science, Scopus, Wiley (Cochrane Database), Embase, and PubMed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed (2020 version), a guide designed to guide the elaboration of systematic literature reviews. One hundred and fifty-seven studies were found, and 23 were selected based on the eligibility criteria. The articles presented were conclusive in determining the importance of the number of axons in the success of nerve transfer. Still, the relationship between the number of axons in the donor and recipient nerves seems more relevant in the success of transfers and is not always explored by the authors. The review of the articles has provided compelling evidence that the number of axons is a critical determinant of the success of nerve transfer procedures. However, the relationship between the number of axons in the donor nerve and that in the recipient nerve appears to be even more crucial for successful transfers, a factor that is not always adequately explored by authors in the existing literature.
- MEDIAN NERVE FASCICLE TRANSFER VERSUS ULNAR NERVE FASCICLE TRANSFER TO THE BICEPS MOTOR BRANCH IN C5-C6 AND C5-C7 BRACHIAL PLEXUS INJURIES: NONRANDOMIZED PROSPECTIVE STUDY OF 23 CONSECUTIVE PATIENTS(2014) CHO, Alvaro Baik; PAULOS, Renata Gregorio; RESENDE, Marcelo Rosa de; KIYOHARA, Leandro Yoshinobu; SORRENTI, Luiz; WEI, Teng Hsiang; BOLLIGER NETO, Raul; MATTAR JUNIOR, RamesThe purpose of this study was to observe whether the results of the median nerve fascicle transfer to the biceps are equivalent to the classical ulnar nerve fascicle transfer, in terms of elbow flexion strength and donor nerve morbidity. Twenty-five consecutive patients were operated between March 2007 and July 2013. The patients were divided into two groups. In Group 1 (n=8), the patients received an ulnar nerve fascicle transfer to the biceps motor branch. In Group 2 (n=15), the patients received a median nerve fascicle transfer to the biceps motor branch. Two patients with follow-up less than six months were excluded. Both groups were similar regarding age (P=0.070), interval of injury (P=0.185), and follow-up period (P=0.477). Elbow flexion against gravity was achieved in 7 of 8 (87.5%) patients in Group 1, versus 14 of 15 (93.3%) patients in Group 2 (P=1.000). The level of injury (C5-C6 or C5-C7) did not affect anti-gravity elbow flexion recovery in both the groups (P=1.000). It was concluded that the median nerve fascicle transfer to the biceps is as good as the ulnar nerve fascicle transfer, even in C5-C7 injuries. (C) 2014 Wiley Periodicals, Inc.