Name: Distal Biceps with Allograft
Uploaded: 2024-05-31T00:00:00.0000000
Duration: T00H05M00S
Description: Distal Biceps with Allograft

Name: Distal Biceps with Allograft

Description: Distal Biceps with Allograft

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Duration: T00H05M00S

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Content URL: https://cadmoreoriginalmedia.blob.core.windows.net/8c87e752-a23c-4714-a15d-4e36c970ed51/Distal Biceps with Allograft.mp4?sv=2019-02-02&sr=c&sig=MVTLui90%2FPqPK9HZI%2Bg4BxBn3wD2FhSyDqLRWA4omvE%3D&st=2024-11-21T21%3A09%3A27Z&se=2024-11-21T23%3A14%3A27Z&sp=r

Upload Date: 2024-05-31T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .
BIJAYENDRA SINGH: Hello, everyone today, I am going to demonstrate a reconstruction of distal biceps rupture using an allograft in a 45-year-old male. He sustained this injury 18 months ago and did not seek any treatment for this. These are his MR scan, a T1 weighted, which shows the retraction at the junction of about upper lower third and mid third junction.
BIJAYENDRA SINGH: And on the stir sequences as well this confirms findings. This shows there is no tendon left. It's most likely to be a stump of the biceps muscle. Patient is under anesthetic and this is the examination and I can feel the stump of the tendons or the muscle belly. Do not use any tourniquet, infiltrate xylocaine with adrenaline, the plane of incision and a lazy S incision with the horizontal limb in the elbow crease going medially distally and on the lateral side proximally.
BIJAYENDRA SINGH: This facilitates use of the lacertus fibrosus if it is present and it can be used either as the graft itself or can be used to reinforce the allografts. What I found is generally for such a long or chronic cases, it is unlikely to be present.
BIJAYENDRA SINGH: Careful dissection looking after any superficial veins, you can potentially preserve one of the two veins across the elbow joint. I often will ligate it and leave it in place so that they can re-cannulate at a later date. I raise thick flaps on both the sides
BIJAYENDRA SINGH: and sure, ensuring hemostasis throughout as the big way in which try and protect it. Once I've raised thick flaps, I suture it to itself and it acts as a retractor as well as an hemostatic agent on the lateral side. We must try and look for the lateral cutaneous nerve of the forearm.
BIJAYENDRA SINGH:
BIJAYENDRA SINGH: So this is showing me that I'm tying off the vein just around the elbow crease. I tend not to cut the vein as it is likely to re-cannulate.
BIJAYENDRA SINGH: As you retract the skin and the soft tissue, the finding the distal biceps tendon of this term can be tricky as the end merges with the arm fascia and one needs to be careful with the neurovascular bundle as well as the brachialis muscle and the musculocutaneous nerve on the lateral side. So here I'm trying to look for where the vessel, the brachial artery and feel for it and identify the fascia, which is often the fibrous structure which sits on top of the brachialis which can be missed.
BIJAYENDRA SINGH: Identify the end of the tendon or the muscle belly, hold it with a tissue forceps as you can see here, it's merged in the. [VIDEO ENDS]

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