Wednesday, August 7, 2019 ((rezonodwes.com)) – The team of the orthopedic-traumatology surgery department of the Justinien University Hospital of Cap-Haitien continues to achieve feats.
Indeed, two years after having made the first total knee replacement in Haiti, the team led by Professor Hubert Michel Pierre-Louis has just achieved another surgical feat by getting to repair the nerves completely dead. a 36 year old patient who had been a victim of a road accident.
Fanfan Success, the patient aged 36, father of five children, native of Hinche, was victim on February 22, 2019 of an accident of the public way from which he left with a paralysis of the shoulder and the arms. He would have consulted several doctors of the place, but no solution was found for his problem which became more and more worrying for him and for his family of which he is the only boss.
After more than 5 months of disappointing consultations, he was informed about the skills of the orthopedic-traumatology department head of the Justinian University Hospital and the results obtained by the team of this service. Mr. Success has decided to come here in order to find a solution.
Success was first received by the residents of the service who did not take long to screener well in a thorough examination to understand the reasons that led him to consultation. Then they decided to conduct a very thorough physical examination which led to the following diagnosis:
1- atrophy of the deltoid, trapezius, supraspinous, pectoral muscles and muscles of the anterior compartment of the arm;
2- loss of shoulder abduction and shoulder sensitivity
3- lowering of shoulder stump
4- inability to perform elbow flexion
As the principles dictate, the patient was presented to the head of department to make the final decision on what to do about such a case. The professor who decides to push challenges to raise the level of orthopedics in Haiti immediately asked to prepare the patient for surgery. He wants to perform the first repair of a brachial plexus in Haiti. Preparation – the equipment needed for nerve repairs is extremely expensive and unavailable in Haiti – Dr. Pierre-Louis decided to go after his goals.
He first acquired a neurostimulator, a device used not only to identify the nerves but also to verify their viability; in the absence of the fibrin glue which would serve to assemble the strands of the living nerves on the dead nerves, he was able to use suture threads of small calibres (9-0 and 10-0) with the help of special glasses costing them. also a fortune.
The Reurotization Technique
Invented in 1912 by Tuttle, neurotization is a technique that consists of grafting one or more fascicles of a living (functional) nerve onto a dead nerve in order to render functional a muscle that was denervated, so non-functional. This technique involves the sacrifice of all or part of the donor nerve causing only minimal sequelae for the patient. The selected nerve is disconnected from its original innervation territory and then sutured to the post-lesional part of the recipient nerve, thereby providing it with axonal regrowth buds. However, it is a bit difficult because one must not only revive a dead nerve but one must keep the nerve taken alive.
Thus, Professor Hubert Michel Pierre Louis had decided to operate the patient in two stages. The first intervention was performed on July 12, 2019. “We did what we call the double neurotization of the musculocutaneous nerve responsible for the innervation of the main muscles of the flexion of the elbow (the brachial biceps and the anterior brachii) by fascicles of the ulnar and median nerve. This intervention lasted about 2 hours.
Following the first intervention, the second was performed under general anesthesia, but with a duration twice as long. It was performed on July 23, 2019.
“Neurotized the axillary nerve with fascicles of the nerve of the long portion of the triceps, branch of the radial nerve and neurotization of the suprascapular nerve with fascicles of the nerve spinal.
Even if the recovery time of nerves repaired is relatively long (8 months on average), the team of orthopedic-traumatology surgery can be proud of having been able to perform this delicate surgical operation with only Haitian doctors and in a hospital where the means are lacking.