Axillary Nerve Reconstruction in 176 Posttraumatic Plexopathy Patients

Terzis, Julia K.; Barmpitsioti, Antonia

doi:10.1097/prs.0b013e3181c496e4

Cited by 55 publications

(39 citation statements)

References 52 publications

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“…9 Best results can be achieved in cases with a preserved proximal stump of the axillary nerve that can be reconstructed via end-to-end suturing using a short nerve graft. 30 If the proximal stumps of C5-6 roots are unavailable, in cases of the avulsion or high rupture of the C5-6 roots, neurotization techniques can be used for reconstruction of the recipient nerves.…”

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confidence: 99%

End-to-side neurorrhaphy in brachial plexus reconstruction

Haninec¹,

Mencl²,

Kaiser³

2013

JNS

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Object. Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy.Methods. From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window.Results. The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair.Conclusions. The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.

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confidence: 99%

End-to-side neurorrhaphy in brachial plexus reconstruction

Haninec¹,

Mencl²,

Kaiser³

2013

JNS

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“…12 In 2009, Terzis et al looked at axillary nerve reconstructions in posttraumatic plexopathy patients and found that people younger than 20 years obtained superior deltoid power (mean = M3.18) than those older than 20 years (mean = M2.70). 10 Poor outcomes have also been associated with older patients receiving nerve transfers. In 2012, Lee et al found that deltoid strength after triceps to axillary nerve transfer correlated negatively with the age of the patient (age range, 16-79 years).…”

Section: Discussionmentioning

confidence: 99%

“…6,8,9 Despite these positive findings, the literature continues to correlate increased age with poor outcomes for brachial plexus reconstructions. 2,4,[10][11][12] We present a 74-year-old male who was presented with brachial plexus palsy after a ski accident. Triceps to axillary nerve transfer, spinal accessory to suprascapular nerve transfer, and ulnar to musculocutaneous nerve transfer were performed with excellent functional outcome.…”

Section: Introductionmentioning

confidence: 99%

Successful Nerve Transfers for Traumatic Brachial Plexus Palsy in a Septuagenarian

Johnsen

Wolfe

2016

Hand (New York, N,Y.)

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Background: Conventional wisdom and the available literature demonstrate compromised outcomes following nerve reconstruction for traumatic brachial plexus palsy in the elderly. We present a 74-year-old male who was reconstructed with multiple nerve transfers for brachial plexus palsy after a ski accident. Methods: Triceps to axillary nerve transfer, spinal accessory to suprascapular nerve transfer, and ulnar to musculocutaneous nerve transfer were performed 16 weeks post injury. Results: At 11 years post-op, the patient could abduct to 65° and forward flex at M4 strength, limited only by painful glenohumeral arthritis. Elbow flexion was M5-at both the biceps and brachialis, and bulk and tone were nearly symmetrical with the opposite side. Eleven-year electrodiagnostic studies demonstrated reinnervation and improved motor unit recruitment all affected muscles. Conclusion: This case questions the widely held dogma that older patients who undergo brachial plexus reconstruction do poorly. Given the short reinnervation distance and optimal donor nerve health, nerve transfers may be an excellent option for healthy older patients with traumatic brachial plexus palsy.

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“…Nerve transfers are a recognized treatment option for patients with traumatic brachial plexus injuries [5]. To maximize shoulder function, notably shoulder abduction and external rotation, simultaneous reconstruction of the suprascapular and axillary nerves is often advocated [6,7].…”

Section: Introductionmentioning

confidence: 99%