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Gradual Fibrotomy: surgical treatment for cerebral palsy or acquired brain injury

Although there is no cure for cerebral palsy or acquired brain injury, it is not only possible, but also recommendable, to treat its long-term physical effects. The treatment of patients with cerebral palsy or acquired brain injury should be multidisciplinary and always aim for the improvement of the patient’s quality of life in order to reach treatment goals more efficiently. The main areas of treatment include avoiding joint deformations, postural hygiene and the improvement of mobility, speech or the quality of everyday activities. The Gradual Fibrotomy method contributes greatly to the effectiveness of the treatment offered by physiotherapists, rehabilitators, speech therapists and occupational therapists on a regular basis.
The Gradual Fibrotomy method is a multilevel surgical technique that was developed by the doctor and Professor Ulzibat as a specific surgical treatment of the effects of brain injury (including cerebral palsy, stroke or acquired brain injury by trauma). The procedure usually takes place under general anesthesia as small incisions are made on the external muscular system. Basically, the method consists of the percutaneous elimination of muscular or fascia fibers that are hardened and that impede the normal functioning of a joint. The aim of the procedure is to improve one or more of the most evident effects of brain injury in patients with cerebral palsy or similar.

- Improve joint movement (active of passive, depending on the degree of neuronal damage). This improves ambulation and object manipulation in patients with cerebral palsy or acquired brain injury.

- Reduce or eliminate muscle or myofascial pain, which is often present in patients with spasticity (congenital or acquired). This treatment is also useful in cases where myofascial pain hinders normal everyday life in patients even if there isn’t a component of spasticity (such as patients with fibromyalgia).

- Avoid joint deformation. Deformations will appear eventually if no orthopedic surgical treatment is applied, especially in patients with cerebral palsy. For them, the Gradual Fibrotomy method becomes a treatment option that offers high therapeutic value, with a good ratio between benefits and possible risks.

- Reduce drooling and improve swallowing. It is possible to improve these two issues related to brain injury associated conditions by intervention on specific facial muscles. The Gradual Fibrotomy method requires the use of small dimension surgical instruments that enable the intervention on those muscles with varying levels of success and barely any facial scarring.

During an initial consultation, we evaluate the patient’s situation and establish the objectives to aim for with the Gradual Fibrotomy method, considering posterior treatment by physiotherapists and occupational therapist as key elements in attaining the set objectives with greater efficiency.
An important quality of the Gradual Fibrotomy method is its universality, because is serves for the treatment of different conditions regardless of etiology. It offers high functionality as it is possible to treat more than on muscle or muscular group simultaneously, attending to their synergism antagonism, and therefore, increasing the effect of the intervention. It enables considerable progress in other therapies as it facilitates the patient’s active or passive mobility. The help offered to physiotherapists, speech therapists and occupational therapists is significant in patients with cerebral palsy or acquired brain injury, especially in those cases where rehabilitation is at a standstill or where compromised bone quality is beginning to constitute a problem.


The Gradual Fibrotomy method is indicated for the treatment of a wide range of conditions regardless of their etiology: severe muscle contractures and myofascial pain syndromes, (such as those seen in spastic conditions like cerebral palsy, hemiplegia, diplegia, and spastic paraplegia), head or spinal cord injuries, fibromyalgia, plantar fasciitis, etc.
This method is a rehabilitation technique that contributes greatly to improvements in the quality of life of patients by improving the active or passive mobility and reducing the associated pain.
It is indicated for patients with myofascial pain syndrome or with established muscle contractures (causes by spasticity or not) that have not been resolved by previous treatments.

Type of surgery

The Gradual Fibrotomy method is a minimally invasive surgical procedure that produces minimal injuries, minimal skin incisions and negligible blood loss or scarring.
Some of the advantages of this technique are:
low traumatic level: very small wounds that are easy to heal;
high versatility: different muscular groups can be treated during the same operation;
quick surgical procedure: since there is no need of additional procedures during the surgery, it reduces the anesthesia time, eases the patient’s post anesthetic state and decreases greatly the possibility of post-surgery complications;
low risk level: no complete muscle incision or surgical intervention on tendons or bones is performed. Therefore, compared to traditional surgeries, its microinvasive approach and minimal dimension of the incisions (only few mm), drastically reduce the risks and patients can easily take care of their surgical wounds;
compatibility with a variety of other therapies, adding to their benefits. It facilitates both active and passive patient mobilization and rehabilitation.

After the surgery

Since this technique preserves skeletomuscular and tendon structure with no full width muscle resections or muscle transposition, it does not require any post-op immobilization or orthopedic devices. The technique enables a quick and stable recovery and an early return to everyday activities.

At Medical Service we are especially interested in establishing direct contact with the team of health professionals that treat the patient in order to reach the highest goals.