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TMR Using a Free Rectus Flap After Transhumeral Amputation
Logan G. Galbraith, James R. Gatherwright
Northeast Ohio Medical University College of Medicine, The Cleveland Clinic
2023-01-31
Presenter: Logan Galbraith
Affidavit:
James Gatherwright
Director Name: James Gatherwright
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
This case report calls attention to the plastic surgeon's obligation to innovation by presenting a case of TMR that has never been done to our knowledge.
Case:
We present a 28-year-old female who sustained a right arm crush injury while involved in a vehicular roll-over collision requiring right transhumeral amputation. The patient's local flap became compromised, and a free tissue transfer with TMR was planned. The areas of necrosis at the amputation site required debridement before proceeding. Radial, median and ulnar nerve neuromas were resected and pedicled nerve transfer was used to graft each into a free right rectus flap. Free tissue transfer with integra was used to envelope the amputation stump. The patient experienced no complications post-op other than anemia due to acute blood loss. In the following months, the patient reported no phantom pain or uncomfortable sensations. In addition, the patient gained the ability to control the firing of three distinct regions of the rectus flap.
Discussion:
Transhumeral amputation leaves patients with three major nerve dissections. With the loss of these nerves comes the loss of abduction, adduction, extension and rotation of the arm. The surgeon's goal was to restore these mechanics, through powered prothesis. The rectus flap having three innervation regions offered the unique opportunity to perform TMR with three separate nerves grafted into a single flap. This technique produced three unique "contact points" for controlled nerve triggering of a fitted prosthesis. This case accentuates the surgeon's call to innovation in the field of plastic surgery.
