MYOTENOPHASCIOTOMY

The following may be treated: Sequelae of cerebral palsy, skull-brain trauma (ECA), stroke and stroke (HCV) and brain malformations, hemiparesis, diparesis, paraparesis, tetraparesis, etc…

Deformities of the feet (equine feet, zambos, etc.), the hands (obstetric brachial paralysis), the neck (congenital torticollis) and others originating from spasticity or mixed forms.

One of the main aftermath of these pathologies is myofascial retractions that can form in the striatum muscles of the human body.

For the first 2 years after receiving brain damage, muscles over-contracted by continued spasticity (muscle hypertone) suffer from metabolic problems (such as lack of oxygenation, nutrition, excess lactic acid, etc.) This causes the development of a degenerative dystrophy process in fibrous tissue fibers mainly in fascias, muscles, tendon tissue or other tissue.

Some fibers are shortened and devitalized with myofascial retractions that limit the extensibility of muscle and movements. These retractions together with spasticity cause poor postures and positions, partially block the normal growth of some part of the body and exacerbate the degenerative process of dystrophy by compressing blood vessels and peripheral nerves.

In myofascial retraction areas, the symptom of pain usually arises, causing more spasticity, which in turn favors the formation of new retractions. In this way a vicious circle is restored: “pain-spasticity-retraction-pain”.

Retractions can be more or less rigid depending on the severity of the disruptive factor and the degenerative process of dystrophy in pathological fibers.

If myofascial retractions are severe and lead to a lot of stiffness over time they cause dysplasias, dislocations, bone deformities and dysmetry. At the same time, joint contractures (joint fusion) are formed as a result of movement limitation (usually at the age of 8 – 12 years).

Doctors’ efforts to recover mostly the reversible part of brain damage and evade the sequelae do not always have the desired result at the muscle level, because there are already myofascial retractions that became independent of their causing factor (brain damage) and often only patients get relief, temporarily.

Traumatologists use different corrective techniques for such retractions and their sequelae, ranging from thetomies to osteotomies and reconstructive operations on the bone-tendinous apparatus that can be quite invasive. The results of these operations are not always efficient and are sometimes even counterproductive (lax feet, recurvatum, excessive abduction, etc.).

Selective and closed myotenophasciotomy is a minimally invasive intervention, which allows the muscles to be freed from myofascial retractions by sectioning only shortened fibers. The intervention is performed with a fine scalpel by percutaneous access and with great precision (without opening and thus avoiding the subsequent suture and scarring). All this respecting healthy tissues and their layers.

1.- During the preoperative visit, the intervention zones are determined even if they can be modified during the preoperative visit.

2.- Operations are performed under general inhalation anesthesia without intubation and last approximately 30 minutes.

3.- No subsequent gypsum or similar immobilization is required.

4.- This is a major outpatient surgery but considering that most patients are foreign, the optimal period of stay in the hospital is 24 hours. After this time the dressings are removed and the patient can move to his home or hotel.

5.- Post-operative pain is not severe. Pain relievers (ibuprofen or acetaminophen) are recommended for the first 4 days (2-3 shots per day being last taken 1 hour before bedtime).

6.- Sometimes bruising may occur in some operated areas. In this case you should apply cold (using a cold bag) for the first 4 days. Local hardening may also appear provisionally without prejudice to results, which are solved alone and without requiring any treatment.

7.- Through this non-invasive operation, it is possible to successfully treat up to approximately 22 retraction zones in different areas of the body (multilevel surgery) in a single phase. If there are more retractions, it is possible to operate in 2 or more phases with a minimum interval of 8-10 months between interventions.

8.- There is a 25% chance that over the years there will be new myofascial retractions due to growth and increased movements. However, most patients do not return to the state before surgery.

9.- The frequency of operations is subject to the particularities of each patient, the course of their illness and the physician’s judgment.

• Acute infectious disease.
• Severe somatic disease in the decompensation phase.
• Very delicate general health (severe respiratory problems, extreme epileptic status…)
• Severe blood clotting problems.
• Allergy to all anesthesia preparations.

• Maximum possible reduction in stiffness
  Approaching the normality of the extensibility of fibrous tissue (fascia, muscle, tendon tissue or other tissue).
• Improvement of blood supply and metabolism of tissues in the intervened areas.
• Decreased degenerative dystrophy process and recovery of fibrous tissue vitality.
• Decreased spasticity
• Increased muscle mass and strength.
• Improved muscle control.
• Elimination or decrease of muscle pain (if present), breaking the vicious circle: “pain-spasticity-retraction-pain”
• Possibility of reduction or cancellation of the use of botulinum toxin and myorelageant drugs (baclofen, lioresal). Always under medical control.
• Development of new connections in the central nervous system (especially at the propioceptive level) by improvements obtained with “bottom to top” influence.
  Such results are possible as long as the problem is caused by myofascial retractions.

Considering that most patients have acquired brain damage (which could have occurred during the intrauterine period, during childbirth, postpartum, or during life), the healthy nature of the patient’s body may benefit from the release of myofascial retractions by showing functional results:

• Increase and improvement of movements (active and/or passive) in the affected segments of the motor system.
• Improvement of motor skills/mobility of hands, arms, legs and other areas.
• Stabilization or correction of pathological positions and postures.
• Improved balance, seating and verticalization, as well as the possibility of improvement of the type of displacement or gait.
• Maximum approximation of the normality of biomechanical parameters (symmetry, alignments, etc.) of patients.
• In children: release of growth and formation of the body in general.
• Improvement in chewing, swallowing, pronunciation, speech, breathing and expectoration.
• Prevention or stabilization of orthopedic problems such as subluxations, joint contractures, bone deformities, recurvatum and dysmetry if they are not serious (at the same time require orthopaedic attention).
• Improved temperature in the extremities
• Decreased or eliminated constipation.
• Decreased or eliminated hatrabism and improvement of sight.
• Decreased or eliminated headache and improvement of psychic-emotional balance and personal well-being.
• Improvement of conditions for general evolution by giving opportunities to the neuroplasticity of patients and facilitating access to physiological patterns.
• Ease of care that family members should provide to the patient.
• Postoperative recovery is simple and requires compliance with the recommendations prescribed by your doctor. The lower limbs, because they have a significant load, need a short period of recovery and adaptation to new postures even if they are good. Patients need 2 weeks to get back on their feet and those who moved on their own before the intervention 3 weeks to start the displacements.

The results begin to be appreciated, depending on the areas operated and according to the particular characteristics of the patient. In some muscles they can be observed the next day, while in others they can go on weeks or months (up to 6 months).

Considering that this group of patients has multifactorial problems, in some cases excessive spasticity or other altering factor (dysphonia, laxity of some joints, etc.) does not allow to enjoy the positive results of treatment. In such a case, patients may require the attention of other professionals.

From 1 month after the operation patients must return to their therapists, rehabilitologists or other specialists to be evaluated according to their new situation. The evaluation of the changes obtained and the rethinking of the physiotherapeutic tactic are essential for the treatment of current problems and to maximize the rehabilitation of each patient.

To obtain the best results, it is recommended to start joint mobilizations from 3 weeks and start strengthening and re-educating the muscles a month after the intervention gradually.

Joint problems should also be treated: contractures or laxity (if any) by performing stretches, using orthopedic procedures such as insoles, orthoses, bipeders, walkers and at the same time applying physiotherapeutic techniques to intensive techniques (last from 3 months).

The intensity and type of exercise will depend on the characteristics of each patient and the professional criterion of the physical therapist who attends to him, always seeking the maximum development of autonomy.