What has changed in brachial plexus surgery?

Rezende, Marcelo Rosa de; Silva, Gustavo Bersani; Paula, Emygdio José Leomil de; Júnior, Rames Mattar; Camargo, Olavo Pires de

doi:10.6061/clinics/2013(03)r02

Cited by 8 publications

(7 citation statements)

References 55 publications

(63 reference statements)

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“…The SAN contains approximately 1500 motor axons (C1 to C6) and was first used for MCN neurotization in 1980 by Marcelo Rosa de Rezende [29]. The SAN is harvested by an anterior approach for transfer to the MCN connected with a nerve graft (Figure 8) [30].…”

Section: Spinal Accessory Nerve (San)mentioning

confidence: 99%

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Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

Stamate¹,

Moraru²

2022

Brachial Plexus Injury - New Techniques and Ideas

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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.

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Section: Spinal Accessory Nerve (San)mentioning

confidence: 99%

“…PhN contains 800 myelinated motor axons (C3, C4, C5) and is a good donor nerve but we should not forget its contribution in the respiratory function [33]. Phrenic nerve (PhN) transfer to the MCN is not recommended in patients with previous pulmonary diseases or for children under the age of two years [29].…”

Section: Phrenic Nerve (Phn)mentioning

confidence: 99%

Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

Stamate¹,

Moraru²

2022

Brachial Plexus Injury - New Techniques and Ideas

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“…In this review, we focus on this type of proximal motor lesion, the ventral spinal root avulsion. Various forms of postganglionic brachial plexus lesions are beyond the scope of this review and are discussed elsewhere (Narakas, 1985;Shin et al, 2005;Kirjavainen et al, 2007;Rezende et al, 2013).…”

Section: Clinical Featuresmentioning

confidence: 99%

Clinical and neurobiological advances in promoting regeneration of the ventral root avulsion lesion

Eggers

Tannemaat

Winter

et al. 2015

Eur J of Neuroscience

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Root avulsions due to traction to the brachial plexus causes complete and permanent loss of function. Until fairly recent, such lesions were considered impossible to repair. Here we review clinical repair strategies and current progress in experimental ventral root avulsion lesions. The current gold standard in patients with a root avulsion is nerve transfer, whereas reimplantation of the avulsed root into the spinal cord has been performed in a limited number of cases. These neurosurgical repair strategies have significant benefit for the patient but functional recovery remains incomplete. Developing new ways to improve the functional outcome of neurosurgical repair is therefore essential. In the laboratory, the molecular and cellular changes following ventral root avulsion and the efficacy of intervention strategies have been studied at the level of spinal motoneurons, the ventral spinal root and peripheral nerve, and the skeletal muscle. We present an overview of cell-based pharmacological and neurotrophic factor treatment approaches that have been applied in combination with surgical reimplantation. These interventions all demonstrate neuroprotective effects on avulsed motoneurons, often accompanied with various degrees of axonal regeneration. However, effects on survival are usually transient and robust axon regeneration over long distances has as yet not been achieved. Key future areas of research include finding ways to further extend the post-lesion survival period of motoneurons, the identification of neuron-intrinsic factors which can promote persistent and long-distance axon regeneration, and finally prolonging the pro-regenerative state of Schwann cells in the distal nerve.

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“…Until the 1960s, few treatment options were available [2]; currently, however, we have a large therapeutic arsenal that provides a better likelihood of upper limb functional recovery. Among countless advances [3,4], different types of neurotization have been described [5], which involves the transfer of a nerve preserved in the lesion to another muscle with a more important function, thus expanding the therapeutic possibilities as this strategy was previously restricted to brachial plexus reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration

Rezende

Veronesi

Paulos

et al. 2020

International Orthopaedics (SICOT)

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Purpose In upper and chronic brachial plexus injuries for which neurological surgery is not a good treatment option, one possibility for gaining elbow flexion is free functional muscle transfer. The primary aim of our study was to evaluate the elbow flexion gain achieved by free gracilis muscle transfer with partial ulnar nerve neurotization. Methods This surgery was performed in 21 patients with upper and chronic (> 12 months) brachial plexus injuries. The level of injury, patient age, the time between trauma and surgery, the affected side, and the aetiology of the lesion were recorded. The primary outcome evaluated was elbow flexion muscle strength, which was measured using the British Medical Research Council (BMRC) scale, in patients with a minimum follow-up period of 12 months. The criterion used to classify elbow flexion as good was a grade of M4 or higher. Results An M4 elbow flexion strength gain was observed in 61.9% of the patients. A gain of M2 or higher was observed in 95.2% of the patients. The mean range of active motion was 77°(range 10 minimum-110 maximum). Conclusion In patients with upper and chronic brachial plexus injuries, free gracilis muscle transfer with ulnar nerve neurotization yields a satisfactory gain in elbow flexion strength and is therefore a good treatment option.

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What has changed in brachial plexus surgery?

Cited by 8 publications

References 55 publications

Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

Clinical and neurobiological advances in promoting regeneration of the ventral root avulsion lesion

Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration

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