scholarly journals Collateral branches of the brachial plexus as donors in nerve transfers

2012 ◽  
Vol 69 (7) ◽  
pp. 594-603 ◽  
Author(s):  
Miroslav Samardzic ◽  
Lukas Rasulic ◽  
Novak Lakicevic ◽  
Vladimir Bascarevic ◽  
Irena Cvrkota ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Statistical Significance ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Quality Of Recovery ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Thoracodorsal Nerve

Background/Aim. Nerve transfers in cases of directly irreparable, or high level extensive brachial plexus traction injuries are performed using a variety of donor nerves with various success but an ideal method has not been established. The purpose of this study was to analyze the results of nerve transfers in patients with traction injuries to the brachial plexus using the thoracodorsal and medial pectoral nerves as donors. Methods. This study included 40 patients with 25 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. The results were analyzed according to the donor nerve, the age of the patient and the timing of surgery. Results. The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100%, 93.7% and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5%, 83.3% and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. Conclusion. According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery.

scholarly journals Medial Pectoral Nerve to Axillary Nerve Neurotization following Traumatic Brachial Plexus Injuries: Indications and Clinical Outcomes

Hand ◽  
2011 ◽  
Vol 7 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Wilson Z. Ray ◽  
Rory K. J. Murphy ◽  
Katherine Santosa ◽  
Philip J. Johnson ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Clinical Outcomes ◽  
Axillary Nerve ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve

scholarly journals Functional Evaluation of Levator Scapulae Tendon to Supraspinatus in Adult Brachial Plexus Injuries

2021 ◽  
Author(s):  
Venkata Koteswara Rao Rayidi ◽  
Srikanth R. ◽  
Jagadish Kiran C.V. Appaka
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Late Presentation ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Functional Evaluation ◽  
Nerve Transfers ◽  
Primary Surgery ◽  
Levator Scapulae ◽  
Transfer Procedures

Abstract Introduction Brachial plexus injuries are severe life-altering injuries. The surgical method to restore shoulder abduction in adult upper brachial plexus injuries involves the usage of nerve grafts and nerve transfers targeting the suprascapular and/or the axillary nerve. When the primary nerve surgery has been unsuccessful or recovery has been incomplete or with a late presentation, muscle transfer procedures are needed to provide or improve shoulder abduction. Levator scapulae to supraspinatus is a transfer to improve shoulder abduction in posttraumatic brachial plexus injuries. Material and Methods The study included 13 patients with the age ranging from 17 to 47 years with a mean age of 30 years. All these patients had preop shoulder abduction of Medical Research Council (MRC) grade ≤3. All had a minimum of MRC grade 4 of active elbow flexion. Eleven patients had primary surgery. Only patients with a minimum of 1 year postoperative follow-up were included. All 13 patients underwent levator scapulae transfer only. Results All patients had a stable shoulder postoperatively. The average increase in active shoulder abduction was from 6.15°(median: 0°) preoperatively to 61.92°(median: 60°), with an average gain in shoulder abduction of 49.61°(median: 50°). Conclusions Transfer of levator scapulae tendon to the supraspinatus is an option to improve shoulder abduction in posttraumatic brachial plexus. In conditions where supraspinatus alone is not functioning, levator scapulae is the best available transfer, considering its strength and maintaining the form of the shoulder unlike trapezius transfer. In patients with previous surgery where supraspinatus has recovered partially but not functionally significant, this tendon transfer can be considered for the augmentation of the existing shoulder abduction.

scholarly journals Outcome of double nerve transfer close to target muscle both for shoulder abduction and elbow flexion in early C5 –C6 Brachial Plexus injury.

2020 ◽  
Vol 27 (07) ◽  
pp. 1442-1447
Author(s):  
Husnain Khan ◽  
Muhammad Shafique ◽  
Zahid Iqbal Bhatti ◽  
Tehseen Ahmad Cheema
Keyword(s):  
Brachial Plexus ◽  
Posterior Approach ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Motor Branch ◽  
Nerve Transfers

Adult brachial plexus injury is a now a common problem due to high incidence of motorbike accidents. Among all types, C 5 and C6 (upper brachial plexus injury) is the most common. If the patient present within 6 months then nerve transfer is the preferred treatment. However, there are different options for nerve transfer and different approaches for surgery. Objectives: The objective of the study was to share our experience of nerve transfer close to target muscles in upper brachial plexus injury. Study Design: Quaisi experimental study. Setting: National Orthopaedic Hospital, Bahawalpur. Period: January 2015 to June 2018. Material & Methods: Total 32 patients were operated with isolated C5 and C6 injury. In all patients four nerve transfers were done. For shoulder abduction posterior approach was used and accessory to suprascapular nerve and one of motor branch of radial to axillary nerve were transferred. Modified Oberlin transfer was done for elbow flexion. Both shoulder abduction and elbow flexion was graded according to medical research council grading system. Results: After one year follow up more than 75% of the patients showed good to normal shoulder abduction and 87.50% showed good to normal elbow flexion. Residual Median nerve damage was noted only in two patients (6.25%). Conclusion: If there is no evidence of recovery up to three months early nerve transfer should be considered, ideal time is 3-6 months. Nerve transfer close to target muscle yields superior results. The shoulder stabilizers and abductors should ideally be innervated by double nerve transfer through posterior approach. Similarly double fascicular transfer (modified Oberlin) should be done for elbow flexion.

scholarly journals Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

2021 ◽  
Author(s):  
Teodor Stamate ◽  
Dan Cristian Moraru
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Distal Stump ◽  
Brachial Plexus Palsy ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Intercostal Nerves ◽  
Thoracodorsal Nerve

Nerve transfers (NT) consist in sectioning a donor nerve and connecting it to the distal stump of a recipient unrepairable nerve. For elbow flexion restoration in brachial plexus palsy (BPP) we used different NT: 1) GF motor Ulnar Nerve to Biceps nerve (Oberlin technique), 2) Double fascicular median/ulnar to biceps/brachialis nerve transfer (Mackinnon), 3) InterCostal Nerves (ICN) to MCN (+/− nerve graft), 4) Medial Pectoral Nerve (MPN) to MCN, 5) ThoracoDorsal Nerve (TDN) to MCN, 6) Spinal Accessory Nerve (SAN) to MCN transfer, 7) Phrenic Nerve (PhN) to MCN, 8) Cervical Plexus C3-C4 to MCN and 9) Contralateral C7 (CC7). I want to present my personal experience using the phrenic nerve (PhN), the intercostal nerves (ICN) and Oberlin’s technique. The aim of this retrospective study is to evaluate the results of this procedure in BPP. NT is an important goal in BPP. ICN transfer into the nerve of biceps for elbow flexion recovery is a reliable procedure in BPP. ICN transfer for triceps offers a positive alternative (Carroll transposition). Oberlin technique is simple and offers better results in a shorter amount of time and is an effective and safe option.

scholarly journals Functional Restoration of Elbow Flexion in Nonobstetric Brachial Plexus Injuries: A Meta-Analysis of Nerve Transfers Versus Grafts

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Pavlos Texakalidis ◽  
Nathan Hardcastle ◽  
Muhibullah S Tora ◽  
Nicholas M Boulis
Keyword(s):  
Brachial Plexus ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Elbow Flexion ◽  
Pooled Analysis ◽  
Functional Restoration ◽  
Surgical Approaches ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Transfer Procedures

Abstract INTRODUCTION Restoration of elbow flexion is the priority in traumatic brachial plexus injuries. Surgical approaches commonly include nerve transfers and nerve grafting. Our objective was to evaluate the safety and efficacy profile of nerve transfers vs grafting for traumatic nonobstetric brachial plexus injuries. METHODS This systematic literature review was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed until November 2018. A random-effects model meta-analysis was conducted, and the I-square was used to assess heterogeneity. The Medical Research Scale (MRC) score was used to assess the efficacy of the procedures. RESULTS A total of 9 studies comprising 490 patients overall were identified. In the pooled analysis, functional recovery of elbow flexion defined as MRC = M3, was superior in the transfer (N = 272/350, 77.7%) compared to the graft group (N = 99/140, 70.7%); however statistical significance was not reached (OR: 1.95; 95% CI: 0.79-4.83; I2: 58.8%). However, the odds for successful restoration of elbow flexion (MRC = M3) were significantly higher when the ulnar (OR: 12.20; 95% CI: 3.05-48.80; I2: 0%) or pectoral nerves (OR: 9.69; 95% CI: 1.83-51.25; I2: 0%) were used as healthy donors for the transfer compared to the graft procedures. Results between the 2 groups were similar when the intercostal, spinal accessory, thoracodorsal, contralateral C7 and phrenic nerves were used as donors for the transfer procedures. CONCLUSION The ulnar or pectoral nerve to musculocutaneous is associated with statistically significant superior rates of elbow flexion recovery. No differences were identified in the pooled analysis or the subgroups of other donors used in nerve transfers. Future randomized studies or prospective cohorts are needed to validate our results.

Intercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions

2013 ◽  
Vol 39 (6) ◽  
pp. 647-652 ◽  
Author(s):  
W. Pondaag ◽  
M. J. A. Malessy
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Consecutive Series ◽  
Biceps Muscle ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Obstetric Brachial Plexus ◽  
Transfer Group

In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. The present study reports the results of both techniques from a single institution in a consecutive series of 42 patients between 1995 and 2008. From 1995 to 2000 we always used the intercostal nerve transfer, and from 2001 to 2008 both techniques were used. Biceps muscle force ≥Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group ( n = 25) and the intercostal nerve transfer group ( n = 17).

scholarly journals Nerve transfer in brachial plexus traction injuries

2003 ◽  
Vol 60 (5) ◽  
pp. 539-546 ◽  
Author(s):  
Miroslav Samardzic ◽  
Danica Grujicic ◽  
Lukas Rasulic ◽  
Dragoljub Bacetic ◽  
Biljana Milicic
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
The Other ◽  
Brachial Plexus Palsy ◽  
Quality Of Recovery ◽  
Nerve Transfers ◽  
Comparative Statistical Analysis

Background. The aim of this study was to analyze the results of nerve transfer to the musculocutaneous and axillary nerves, using some technical modalities such as intercostal, spinal accessory or intraplexal transfer, and on the basis of the results to try to clarify the most common controversies concerning these operations. Methods. The study included 82 patients with brachial plexus traction injuries, who were operated on using various techniques of nerve transfer. The follow-up period was at least two years. The analysis of biceps and deltoid muscles recovery was performed according to the type of the donor nerve. Results. The corresponding rates of recovery for the musculocutaneous and axillary nerves were 46.7% and 68.1% in intercostal nerve transfer, 71.4% and 75% in accessory nerve transfer, 93.1% and 88.8% in nerve transfer of the brachial plexus collateral branches, and 55.5% and 60% in classical intraplexal nerve transfer, respectively. Comparative statistical analysis demonstrated significantly better final outcome and quality of recovery in regional nerve transfers in comparison to the other methods. Conclusion. Our findings suggest that nerve transfer of collateral branches, where possible, (such as in cases with upper or extended upper brachial plexus palsy) might be a method of choice, offering better results and quality of recovery.

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