Fibrotomy

Surgical Treatment of Gradual Fibrotomy for Cerebral Palsy or Acquired Brain Injury

Although there is no treatment for cerebral palsy or acquired brain damage per se, it is possible and convenient treatment of its sequelae. The treatment goals of the patient with cerebral palsy or acquired brain damage are achieved more effectively when performed in a multidisciplinary way and should always aim to improve the patient's quality of life.
Avoiding deformations, postural hygiene, improving mobility, language or the quality of daily tasks are usually the speeches of the most important work and where the gradual fibrotomy adds an extra efficiency to the treatment that physiotherapists, rehabilitators, speech therapists or occupational therapists monitor regularly.

Gradual Fibrotomy is a surgical technique that can be considered surgery or multilevel microsurgery, developed by Dr. and Professor Ulzibat. It is a surgical treatment for the sequelae of brain damage (cerebral palsy, stroke or acquired trauma) practiced on the patient's external muscular system, usually under general anesthesia. It is practiced with scalpels of small dimensions designed for this purpose called microfibrolotomes and is effective in the treatment of cerebral palsy sequelae and the like . It basically consists of the percutaneous elimination of these fibers at the level of the fascia or muscle, with the result of fibrosis and that prevent or hinder the functionality of a bone joint. The objective pursued is the improvement of one or more of the more obvious sequelae in patients with cerebral palsy or similar.

• Improved joint movement (active or passive, depending on the degree of neuronal involvement), thus improving ambulation or manipulation of objects in patients with cerebral palsy or acquired brain injury.
• Reduction or elimination of muscle or myofascial pain, very present in patients with congenital spasticity or purchased. It is useful in cases where this muscle pain impedes the patient's normal life, although it is not caused by spasticity such as for example, in fibromyalgia.
• Avoid joint deformation. Deformations that will appear sooner or later if some kind of orthopedic surgery, especially in patients with cerebral palsy. At this point, gradual fibrotomy becomes a treatment for patients with cerebral palsy or similar (cerebrovascular accident or acquired trauma) of great therapeutic value with a high level of benefit compared to to possible risks.
• Decreased salivation or swallowing, problems associated with this type of pathology and that can be improved in many cases after intervention in several muscles of the face. Gradual fibrotomy is performed with small instruments, which allows treat this type of muscle with a certain degree of success without leaving a trace on the skin.

During the consultation, the patient's situation is evaluated and the goals to be achieved with the graded fibrotomy are outlined, taking into account the later help from physiotherapists or occupational therapists that will allow a greater degree of effectiveness in the established goals.

It has a universal character because, regardless of the main etiology, it allows different pathologies to be treated at the same time. It offers high functionality by being able to intervene in several muscles or muscle groups at the same time according to their synergism or antagonism, thus increasing the effect of the intervention. Allows a considerable advance of other types of therapies, facilitating active mobility or passive patient. We can say that the help offered to physical therapists, speech therapists and occupational therapists is considerable in patients with cerebral palsy or acquired brain damage, especially in cases where rehabilitation is stalled or bone compromised starts to get worrisome.

To whom It may Concern?

Gradual fibrotomy is an effective treatment in patients with cerebral palsy of the mostly spastic type, spastic paraparesis, sequelae of a stroke or other types of accidents, fibromyalgia, hemiplegia, diplegia, tetraparesis, carpal tunnel syndrome, plantar fasciitis and myofascial pain syndrome. As gradual fibrotomy is a rehabilitative technique, the goal is to achieve an improvement, sometimes a lot important for the patient's quality of life, increasing their active or passive mobility and reducing associated pain. It is generally indicated in patients with established muscle contractures that do not subside with another type of treatment, caused or not by spasticity and / or myofascial pain syndrome.

Type of surgery

It can be considered as multilevel microsurgery, with a minimal level of trauma in the absence of skin cuts, scars and bleeding. No complete sectioning, stretching or transposition of muscles is performed, nor is there an incision in bone structures or tissues. tendon, does not require immobilization or subsequent plastering of the patient, contributing to the patient's early reintegration into their activities. Different areas at different levels of the muscular system can be treated in a single session. It is performed in an operating room and requires anesthesia. which is usually deep sedation without endotracheal intubation.

At MSERCON Medical Services we are especially interested in direct contact with other professionals who care for the patient, in order to achieve the highest goals.

History of Gradual Fibrotomy

Valeri Borisovich Ulzibat is the name of the investigating surgeon and precursor of the surgical technique, called fibrotomy gradual in stages.

He was born in 1946 into a military family and studied medicine at Kemerova University. He comes to exercise like Orthopedic traumatologist and professor of traumatology and orthopedics working in several universities and hospitals in Russia. In 1985 and trying to relieve muscle pain suffered by a close relative, he began to carry out a series of investigations and Surgical interventions leading to the surgical technique of rehabilitation that is now called gradual staged fibrotomies.
For the practice of surgical interventions, he designs and patents a series of specific medical instruments that, although in principle They were manufactured almost by hand, today their manufacture has a complex system.

In 1990, he carried out a series of studies that culminated in the publication of a protocol of recommendations on the methodology of treatment of muscle and myofascial pain which is admitted by the Ministry of Health of the USSR. In December 1996 he defended the thesis of his doctorate in medical sciences. In it, the excellent results of the developed methodology are evident.
Already in 1998 V. B. Ulzibat received the title of researcher emeritus of the Russian Federation and in December 1999 the title of professor.

Gradual Fibrotomy, or Dr. Ulzibat's technique, began to be applied to a whole series of patients with muscular or myofascial diseases. obtaining excellent results in pathologies that cause spasticity (cerebral palsy, fibromyalgia, sequelae of stroke or damage produced by severe trauma, dysplegia, hemiparesis...).
Since 1992 and with the name of Tula Clinical Rehabilitation Institute , he starts working with a team of surgeons, anesthesiologists, neurologist and specialized nursing. Here begins the training of Dr. Alexey Repetunov who has just graduated from the University of Medicine, starts working hand in hand with Dr. Ulzibat. In general, the entire team collaborates in the development and improvement of fibrotomies gradually becoming what it is today. The Institute's physicians defended a total of eight theses with aspects related to fibrotomy and more than 165 scientific articles were published that, at the time, endorsed gradual fibrotomy before the Russian medical community.

The excellent results, especially in patients with infantile cerebral palsy, make patients all over the world start to move to be operated in his clinic and Ulzibat designs a whole work system that leads the clinic to organize trips and stays of patients in Tula.

With Ulzibat at the forefront, the expansion of surgical technique beyond Russian borders and a whole series of conferences and interventions in several medical conferences in several countries around the world, seek to spread the knowledge of the technique in large parts of the world.
Problems with language and the controversy of some of his studies do not favor this issue. Unfortunately Professor Ulzibat dies suddenly in 2004 and many of the extension plans and agreements with other countries (including Spain) are truncated.
His legacy remains in the hands of the Tula Clinical Rehabilitation Institute, which he founded in 1992 and its components are developing new ones. concepts and several modifications of the technique, which are applied today.
Although the technique has been refined and refined in several aspects by his students, the lack of this entrepreneurial character of dr. Ulzibat, tongue problems, and a few other factors delay the expansion of gradual fibrotomies to some extent. out of the Russian Federation after his death.