The intercostobrachial nerve as a sensory donor for hand reinnervation in brachial plexus reconstruction is a feasible technique and may be useful for restoring sensation

Abstract

ARTICLEThe intercostobrachial nerve as a sensory donor for hand reinnervation in brachial plexus reconstruction is a feasible technique and may be useful for restoring sensation O uso do nervo intercostobraquial como doador na restauração cirúrgica da sensibilidade da mão em lesões do plexo braquial é uma técnica anatomicamente viável e pode ser útil para a recuperação sensitiva ABSTRACTObjective: Few donors are available for restoration of sensibility in patients with complete brachial plexus injuries. The objective of our study was to evaluate the anatomical feasibility of using the intercostobrachial nerve (ICBN) as an axon donor to the lateral cord contribution to the median nerve (LCMN). Methods: Thirty cadavers were dissected. Data of the ICBN and the LCMN were collected, including diameters, branches and distances. Results: The diameters of the ICBN and the LCMN at their point of coaptation were 2.7mm and 3.7mm, respectively. The ICBN originated as a single trunk in 93.3% of the specimens and bifurcated in 73.3%. The distance between the ICBN origin and its point of coaptation to the LCMN was 54mm. All ICBNs had enough extension to reach the LCMN. Conclusion: Transfer of the ICBN to the LCMN is anatomically feasible and may be useful for restoring sensation in patients with complete brachial plexus injuries.Keywords: brachial plexus; intercostal nerves; median nerve; nerve transfer; sensation. RESUMOObjetivo: Poucos doadores estão disponíveis para a restauração da sensibilidade em pacientes com lesões completas do plexo braquial (LCPB). O objetivo deste estudo foi avaliar a viabilidade anatômica do uso do nervo intercostobraquial (NICB) como doador de axônios para a contribuição do cordão lateral para o nervo mediano (CLNM). Métodos: Trinta cadáveres foram dissecados. Os dados do NICB e do CLNM foram coletados: diâmetros, ramos e distâncias. Resultados: Os diâmetros do NICB e da CLNM no ponto de coaptação foram 2,7mm e 3,7mm, respectivamente. O NICB originou-se como um único tronco em 93,3% dos espécimes e bifurcou-se em 73,3%. A distância entre a origem do NICB e seu ponto de coaptação com a CLNM foi de 54mm. Todos os NICBs tiveram extensão suficiente para alcançar a CLNM. Conclusão: A transferência do NICB para a CLNM é anatomicamente viável e pode ser útil para restaurar a sensibilidade em pacientes com LCPB.Palavras-chave: plexo braquial; nervos intercostais; nervo mediano; transferência de nervo; sensação.

Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis

“…The systematic review and meta-analysis include twenty-three studies published between 1999 and 2023. Six studies were conducted on cadaveric samples [ 9 , 15 , 16 , 23 , 27 , 28 ], and seventeen were performed intraoperatively [ 2 – 4 , 6 , 10 – 14 , 17 – 22 , 24 – 26 ]. The studies exhibit a broad geographic distribution, with 10 studies from Asia [ 3 , 4 , 9 – 12 , 16 , 18 , 21 , 28 ], 6 from Europe [ 6 , 14 , 19 , 20 , 25 , 26 ], 4 from South America [ 2 , 15 , 22 , 24 ], and one each from North America [ 23 ], Africa [ 17 ], and Australia [ 27 ].…”

“…Six studies were conducted on cadaveric samples [ 9 , 15 , 16 , 23 , 27 , 28 ], and seventeen were performed intraoperatively [ 2 – 4 , 6 , 10 – 14 , 17 – 22 , 24 – 26 ]. The studies exhibit a broad geographic distribution, with 10 studies from Asia [ 3 , 4 , 9 – 12 , 16 , 18 , 21 , 28 ], 6 from Europe [ 6 , 14 , 19 , 20 , 25 , 26 ], 4 from South America [ 2 , 15 , 22 , 24 ], and one each from North America [ 23 ], Africa [ 17 ], and Australia [ 27 ]. Among the twenty-three studies, 1,636 patients were included, and 1,883 axillae were evaluated (494 from cadaveric dissections and 1,389 from intraoperative dissections): 765 from Asians, 570 from Europeans, 318 from South Americans, 200 from North Americans, 30 from Africans, and 28 from Australians (Table 1 ).…”

From Cadaveric Dissection to the Operating Room: A Unilateral Double Intercostobrachial Nerve and the Implications in Axillary Lymph Node Dissection

“…Several studies have reported that the incidence of single-trunk ICBN ranges between 74% and 81.3% [ 10 , 13 - 14 ]. Another study reported an incidence of 93.3% [ 15 ]. Nayak and Banerjee conducted a study in which they identified the origin of the ICBN in 130 axillae; as usual, 100% of the cases presented an ICBN originating from the second intercostal nerve.…”

Novel Uses of Nerve Transfers

“…One technique for restoration of hand sensation is transfer of the intercostobrachial nerve to the lateral cord contribution of the median nerve. With this technique, the intercostobrachial nerve, which is a branch of the second intercostal nerve, is directly coapted to the lateral cord contribution to the median nerve in the infraclavicular space, without the need for an intervening graft [11]. The goal is restoration of sensation to at least a protective level in the median nerve distribution of the hand.…”