United Brachial Plexus Network, Inc.

Anyone heard of this? Apparently it's the surgery that Avery needs. To do with tendon tranfer...

Surgeon will send me information. Just wondering if anyone here is familiar with it.

TIA
Bonnie

Hi Bonnie,
I have never heard of it but am very interested to find out more. Keep us posted,
Shannon

Bonnie,

I think you are referring to the L'Epsicopo procedure with the Hoffer modification which is shoulder surgery for external rotation and abduction (does that sound right?)

If that is the right thing, it is a tendon transfer of the latissimus dorsi and teres major tendons to the rotator cuff for external rotation (the L'Epsicopo part) combined with a pectoralis release (the Hoffer part).

http://www.ncbi.nlm.nih.gov/entrez/quer ... ds=9698004

Interestly, here are some quotes from correspondence about this article in the next journal issue (for those who are concerned about pectoralis release). A Dr. Cullu wrote

"During the operative procedure, the latissimus dorsi and the teres major were released and then were transferred to the rotator cuff. However, no information is given about the released pectoralis major. If this muscle is detached and left untransferred, as in the Sever procedure, the transferred medial rotators might cause an imbalance of the muscles about the shoulder. This procedure also creates a large defect due to retraction of the muscle."

Hoffer and Phipps replied:

"We thank Dr. Çullu for his comments. We are aware that Tachdjian suggested z-lengthening, as described by Green. However, we have been performing releases of the insertion of the pectoralis major since our original article was published in the 1970s. We leave the subscapularis intact and do not release it as
Sever and Green did. Perhaps that is why we have observed no problem with residual weakness in medial rotation. In all of our patients, we have seen that the pectoralis major reattaches, albeit in an elongated fashion.

This does not suggest that casual treatment is appropriate for the rare case of a rupture of the pectoralis major in a normal athlete. However, in disabled children, we believe that the release of the pectoralis major with the subscapularis left intact works just like a lengthening."



Kate

Kate has summed it up better than I ever could. I think we are talking about the surgical procedure created by Dr. Hoffer (pediatric orthopaedic surgeon). He actually originated part of the Mod Quad and I had heard that TCH had approached him long ago about joining their team. When we were gathering multiple opinions regarding surgical procedures, we made a trip to Los Angeles and spent an hour or so with Dr. Hoffer. He was wonderful and very candid with us regarding his views. He is getting older now and may be close to retirement. I would bet most likely that you are talking about the surgical procedure created by, and named after Dr. Hoffer.

Thank you very much for that. It does sound like that's it.

They faxed me a consent form that said "I, blah blah consent to the above procedure.....". The above procedure was "Hoffer Procedure". I had no idea! Of course, I haven't signed the papers yet!

The surgeon is supposed to be sending me an explanation.

Don't sign anything if the doctor hasn't explained the procedure to you! I doubt they expect you to before you see the explanation, though.

It's called "informed" consent for a reason. They are responsible for explaining, in however simple or complex you need them to

- the nature of the decision/procedure
- reasonable alternatives to the proposed intervention
- the relevant risks, benefits, and uncertainties related to each alternative

until you understand. Here is a great site on it... I wish that all doctors followed this protocol!

http://eduserv.hscer.washington.edu/bio ... html#ques2

Hold 'em to it!

Kate

I KNOW!!

Ever since my stint at the hospital last pregnancy (with Avery), I will never, ever again put my complete trust in a medical professional - or any professional, for that matter!

It is a common-sense thing but, unfortunatly some of us are too trusting and convinced that doctors know it all.

I am now one of those "annoying" parents who asks all sorts of questions, looks things up on the Internet, (asks here! lol), and phones the secretary almost daily to ask more questions.

AND I'M DARN PROUD OF IT!! LOL

Have a great day. Thank you very much for your help.

btw - I have written out a fax with my questions and have included at the bottom..."I will be happy to sign the consent form as soon as I feel that I'm am fully informed as to what will happen during Avery's surgery."

Bonnie

LOL about "annoying" parents. I've started to play a game with my husband every time we see a new doctor.

We make bets on how long it will take before they ask me "are you a nurse??" In the beginning it wasn't until the second or third visit, but now it is pretty much within a few minutes of meeting them!


Kate

Hey Kate!
I get the same question!!!! But why do they always ask if I am a nurse and not a therapist?


claudia

My daughter had this done 3 years ago. Before the surgery she could not lift her arm over her head. Now she can touch the top of her head...The best moment was when she could actually give me a two armed hug without having me help her with her arm.