A Systematic Review of Nerve Transfer and Nerve Repair for the Treatment of Adult Upper Brachial Plexus Injury

Yang, Lynda J.‐S.; Chang, Kai-Ting; Chung, Kevin C.

doi:10.1227/neu.0b013e318257be98

Cited by 115 publications

(76 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our approach to pooling data from multiple published reports is similar to that used by Garg et al 21 as well as Yang and associates, 83 although the model itself is somewhat different. Unlike those authors, we extended our analysis to include different nerve transfers and were able to show that partial ulnar transfer seemed to result in greater success in elbow flexion recovery than did graft repair.…”

Section: Discussionmentioning

confidence: 99%

Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Ali

Heuer

Faught

et al. 2015

JNS

View full text Add to dashboard Cite

OBJECT Adult upper trunk brachial plexus injuries result in significant disability. Several surgical treatment strategies exist, including nerve grafting, nerve transfers, and a combination of both approaches. However, no existing data clearly indicate the most successful strategy for restoring elbow flexion and shoulder abduction in these patients. The authors reviewed the literature to compare outcomes of the three surgical repair techniques listed above to determine the optimal approach to traumatic injury to the upper brachial plexus in adults. METHODS Both PubMed and EMBASE databases were searched for English-language articles containing the MeSH topic “brachial plexus” in conjunction with the word “injury” or “trauma” in the title and “surgery” or “repair” as a MeSH subheading or in the title, excluding pediatric articles and those articles limited to avulsions. The search was also limited to articles published after 1990 and containing at least 10 operated cases involving upper brachial plexus injuries. The search was supplemented with articles obtained through the “Related Articles” feature on PubMed and the bibliographies of selected publications. From the articles was collected information on the operation performed, number of operated cases, mean subject ages, sex distribution, interval between injury and surgery, source of nerve transfers, mean duration of follow-up, year of publication, and percentage of operative success in terms of elbow flexion and shoulder abduction of the injured limb. The recovery of elbow flexion and shoulder abduction was separately analyzed. A subanalysis was also performed to assess the recovery of elbow flexion following various neurotization techniques. RESULTS As regards the restoration of elbow flexion, nerve grafting led to significantly better outcomes than either nerve transfer or the combined techniques (F = 4.71, p = 0.0097). However, separating the Oberlin procedure from other neurotization techniques revealed that the former was significantly more successful (F = 82.82, p < 0.001). Moreover, in comparing the Oberlin procedure to nerve grafting or combined procedures, again the former was significantly more successful than either of the latter two approaches (F = 53.14; p < 0.001). In the restoration of shoulder abduction, nerve transfer was significantly more successful than the combined procedure (p = 0.046), which in turn was significantly better than nerve grafting procedures (F = 5.53, p = 0.0044). CONCLUSIONS According to data in this study, in upper trunk brachial plexus injuries in adults, the Oberlin procedure and nerve transfers are the more successful approaches to restore elbow flexion and shoulder abduction, respectively, compared with nerve grafting or combined techniques. A prospective, randomized controlled trial would be necessary to fully elucidate differences in outcome among the various surgical approaches.

show abstract

Section: Discussionmentioning

confidence: 99%

Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Ali

Heuer

Faught

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…In peripheral nerve lesions where there is separation of nerve fibres, a coordinated array of events occur to remove damaged tissue, to make way for the regenerative process, thus a disruption of nerve conductance will result [99]. This in turn will cause axonal degeneration, a process known as Wallerian degeneration (WDG) taking place initially (1-2 days following the trauma) at the distal end of the lesion [49].…”

Section: Injurymentioning

confidence: 99%

“…For proximal nerve or preganglionic (avulsion) injuries, which demand a large amount of nerve tissue to reinnervate their distal nerve element (brachial plexus injury), nerve transfers offer a practical surgical solution and have reported good outcomes in the last decade [99]. Nerve transfers can maximise regenerating axonal input into a degenerated distal nerve (recipient) by sacrificing a less important proximal nerve (donor), thereby providing a return of function to nerves with longstanding injuries [69].…”

Section: Nerve Transfermentioning

confidence: 99%

Nerve repair: toward a sutureless approach

et al. 2014

View full text Add to dashboard Cite

Peripheral nerve repair for complete section injuries employ reconstructive techniques that invariably require sutures in their application. Sutures are unable to seal the nerve, thus incapable of preventing leakage of important intraneural fluids from the regenerating nerve. Furthermore, sutures are technically demanding to apply for direct repairs and often induce detrimental scarring that impedes healing and functional recovery. To overcome these limitations, biocompatible and biodegradable glues have been used to seal and repair peripheral nerves. Although creating a sufficient seal, they can lack flexibility and present infection risks or cytotoxicity. Other adhesive biomaterials have recently emerged into practice that are usually based on proteins such as albumin and collagen or polysaccharides like chitosan. These adhesives form their union to nerve tissue by either photothermal (tissue welding) or photochemical (tissue bonding) activation with laser light. These biomaterial adhesives offer significant advantages over sutures, such as their capacity to unite and seal the epineurium, ease of application, reduced invasiveness and add the potential for drug delivery in situ to facilitate regeneration. This paper reviews a number of different peripheral nerve repair (or reconstructive) techniques currently used clinically and in experimental procedures for nerve injuries with or without tissue deficit.

show abstract

“…5,7,9,11,28,30,[33][34][35][36] Such mapping is important because it provides a precise knowledge of the orientation of individual fascicles in the nerve roots so that nerve repair with or without graft or nerve transfers could be successfully performed.…”

Section: Discussionmentioning

confidence: 99%

A cadaveric microanatomical study of the fascicular topography of the brachial plexus

Sinha¹,

Prasad²,

Lalwani³

2016

JNS

View full text Add to dashboard Cite

There has been a significant development in the management of these injuries over the last decades, especially with the advent of microsurgical techniques, and use of magnification, microsutures, and microinstruments. 26 Many advances have been made in the areas of neurobiology of nerve injury and regeneration, and increasing attempts are being made in the use of nerve allografts and nerve conduits for bridging the gaps. 2,13,14,16 Recently introduced nerve transfer techniques selectively neurotize target muscles close to motor endplates and produce early and consistently good results, especially in the management of upper truncal injuries. 3,15,21,32 The management of brachial plexus injuries involves a combination of comprehensive care, cross-specialty consultations, prolonged hours of surgery, and a protracted period of pre-and postoperative physiotherapy. Even then, the results of surgery may not be favorable. 25 Various modalities have been used in the surgical treatment of these devastating injuries, depending on the type of injury. These modalities consist of either neurolysis, or intra/extraplexal nerve transfer (neurotization), with or without a nerve graft. 3,11,12,26,27 Two factors play a major role in functional recovery after the repair of a nerve lesion. 24 The first factor is the number of axons that successfully cross the anastomotic site. On average, approximately 30% of the axons are lost while traveling across one anastomotic site. However, attempts to prevent the axonal loss across the anastomotic methods The entire right-sided brachial plexus of 25 adult male cadavers was dissected, including all 5 spinal nerves (C5-T1), from approximately 5 mm distal to their exit from the intervertebral foramina, to proximal 1 cm of distal branches. All spinal nerves were tagged on the cranial aspect of their circumference using 10-0 nylon suture for orientation. The fascicular dissection of the C5-T1 spinal nerves was performed under microscopic magnification. The area occupied by different nerve fascicles was then expressed as a percentage of the total cross-sectional area of a spinal nerve. results The localization of fascicular groups was fairly consistent in all spinal nerves. Overall, 4% of the plexus supplies the suprascapular nerve, 31% supplies the medial cord (comprising the ulnar nerve and medial root of the median nerve [MN]), 27.2% supplies the lateral cord (comprising the musculocutaneous nerve and lateral root of the MN), and 37.8% supplies the posterior cord (comprising the axillary and radial nerves). coNclusioNs The fascicular dissection and definitive anatomical localization of fascicular groups is feasible in plexal spinal nerves. The knowledge of exact fascicular location might be translatable to the operating room and can be used to anastomose related fascicles in brachial plexus surgery, thereby avoiding the possibility of axonal misrouting and improving the results of plexal reconstruction.

show abstract

A Systematic Review of Nerve Transfer and Nerve Repair for the Treatment of Adult Upper Brachial Plexus Injury

Cited by 115 publications

References 57 publications

Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Nerve repair: toward a sutureless approach

A cadaveric microanatomical study of the fascicular topography of the brachial plexus

Contact Info

Product

Resources

About