What is it ?

  • Skin grafts
    A degloving injury is a type of avulsion in which an extensive section of skin is completely torn off the underlying tissue, severing its blood supply. Degloving injury is commonly associated with road traffic accidents and may be associated with other underlying injury to bones, tendons, nerves and blood vessels. Typically, degloving injuries affect the extremities and limbs. Degloving injuries invariably require major surgical interventions. Treatment options include replantation or revascularization of the degloved skins, or when these are not possible, skin grafts or skin flaps.
  • Tendon transfer
    Tendon transfer is a surgical process in which the insertion of a tendon is moved, but the origin remains in the same location. Tendon transfer involves redistribution of muscle power. Tendons are transferred at the distal attachment from lesser to more important functions so that the overall function is improved. Tendon transfers provide a modality of surgical treatment when muscle function is lost either due to nerve injuries or injuries to the muscle/tendon unit. Tendon transfers are also performed to correct the imbalanced muscle tone due to spasticity resulting from injuries to the central nervous system.Tendon transfers are used to treat many conditions. They are indicated when muscle function is lost due to nerve injury, and the nerve can no longer send signals to the muscle and cannot be repaired. Some common injuries treated with tendon transfers are radial, ulnar and median nerve injury; foot drop due to peroneal nerve injury; and spine injury as well as hand paralysis due to spinal cord injury.One benefit of moving tendons is that there is no time limitation. The window for successfully repairing nerves is about a year, but a tendon transfer can restore muscle function many years after the initial injury.At Craftsman Preoperative evaluation of the patient is done to map out functional deficits, and determine which muscles are available for transfer. Time from injury, type of injury, and success of previous treatment is taken into account. Electrodiagnostic studies are carried out to determine the extent of motor loss and predict the muscle recovery.The donor muscle must have enough strength (work capacity) to duplicate the recipient function. The work capacity depends upon muscle fiber’s length and cross sectional area, which are proportional to muscle mass and volume. In other words, a larger muscle produces more force and a longer muscle has a greater excursion. There are potential factors that may result in loss of muscle strength including postoperative adhesion, difference in vector of motion.The donor tendon must not result in functional deficit after transfer. The remaining muscles must have enough level of strength to account for the loss of the original function of the donor muscle. Transfers can generally be classified into either power or positional transfers. Power transfers are done to perform motion, and therefore requires relatively more powerful donor muscles. Positional transfers, on the other hand, do not require powerful donors. The strength of the antagonist muscle should be similar to the donor to avoid overcorrection and to maintain correct posture.Dr Nitin Ghag will select tendon transfer or other treatments based on your condition and which technique offers the best chance of recovery.
  • Foot drop
    Foot drop occurs when the muscles and tendons that flex the foot up are no longer working. Commonly, it is the result of a nerve injury, stroke, or nerve disease (neuropathy). It also can occur after an injury to a muscle or tendon. If a person is unable to flex the foot up when walking, the foot or toes can drag on the ground. This can make walking difficult and lead to frequent falls. The goal of a foot drop procedure is to improve a patient’s ability to actively flex the foot and ankle up in situations where this function is weak or lost completely. The most common tendon transferred is the posterior tibial tendon.Recovery:
    The ankle is placed in a splint in the operating room to hold the position of the foot and ankle and protect the newly transferred tendon(s). Strict elevation and non-weightbearing are enforced over the first 10 to 14 days. Stitches are removed in about two weeks, after which the foot will be in a cast for about six weeks. The patient usually is non-weightbearing during this time.Once the cast is removed, the patient will be allowed to walk in a special boot. Physical therapy to retrain the tendon(s) in its new position continues for 8-12 weeks. A night splint is worn for three months after surgery to prevent premature stretching of the tendon transfer.As swelling improves a custom-molded brace can be worn in an athletic shoe and the walker boot is discontinued. Once the patient’s strength and motion are improved with physical therapy, the brace may be discontinued. The goal of the surgery is for the patient to walk in a regular shoe without the need for a brace.

    Risk and complications –
    Potential complications of this treatment can include wound infection, deep infection that can compromise the tendon transfer, and failure of the tendon or tearing of the repair.

  • Wrist drop
    Wrist drop is a disorder caused by radial nerve palsy. Because of the radial nerve’s innervation of the extensor muscles of the wrist and digits, those whose radial nerve function has been compromised cannot actively extend them. As such, the hand hangs flaccidly in a position of flexion when the patient attempts to bring the arm to a horizontal position.Causes of wrist drop are –
    Penetrative trauma, external compression (Saturday night palsy), radial nerve can also be injured if there is a humeral fracture because the radial nerve runs through the radial groove on the lateral border of the bone, Mechanical derangement of the radial nerve need not involve compression. It can also involve enlargement, torsion, and fascicular entwinement. The treatment and management of radial neuropathy can be achieved via the following methods:
  1. Physical therapy or occupational therapy
  2. Surgery (depending on the specific area and extent of damage)
  3. Tendon transfer (the origin remains the same but insertion is moved)[clarification needed]
  4. Splinting

Tendon transfer is the mainstay of treatment. In acute condition or within the time limit primary repair of then nerve can be done or it can be repaired with a nerve graft.
One benefit of moving tendons is that there is no time limitation. The window for successfully repairing nerves is about a year, but a tendon transfer can restore muscle function many years after the initial injury.

The goal of treatment is independent wrist, finger, and thumb extension with thumb abduction. Donor muscles include the pronator teres (PT), flexor carpi ulnaris (FCU), flexor carpi radialis (FCR), flexor digitorum superficialis (FDS) 3 and 4, and palmaris longus (PL).

Timing of surgical intervention is controversial. Conventional surgical recommendations are to proceed after the patient has reached a documented clinical and electromyographic plateau of useful radial nerve regeneration. This typically occurs 1 year after the nerve lesion. Tendon transfers are an available option for reconstructing wrist and finger/thumb extension following radial nerve injury when nerve transfers are contra-indicated. The donor median-innervated tendons are used to reconstruct the recipient radial-innervated tendons.

Here at Craftsman Dr Nitin Ghag and his team would evaluate you thoroughly and plan the approach which would give you the best outcome

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