End-to-side neurorrhaphy in brachial plexus reconstruction

Abstract

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.

Preserved cutaneous silent period in cervical root avulsion

“…18 The diameter and the number of nerve fibers of each nerve root differs in cervical, thoracic and lumbar segments 38 and the better knowledge about preserved nerve fibers continuity provides basic data for future neuroanastomosis. 27 Preserved cutaneous SP proves that spinal cord circuit is functionally intact. This observation may thus have implications in reconstructive surgery as well as in neurorehabilitation with better functional restoration.…”

Surgical Treatment of Brachial Plexus Injury

“…So far, numerous methods of musculocutaneous nerve neurotization have been defined. Successful reinnervation with this technique has been obtained using: (1) the medial pectoral nerve (84-91%), (2) the intercostal nerves (44-70%), (3) phrenic nerve (66%), and (4) spinal accessory nerve (50-88%) as donor nerves [1,20]. The intercostal nerves may be destructed in patients with rib fractures.…”

“…The major benefit of this technique is the option to create a distal suture close to the target muscle [18,24,25]. However, we do not use this particular method in musculocutaneous nerve reconstruction because we have had very positive experiences using the pectoral nerves for neurotization of this nerve [20].…”

“…This situation is expected in patients with combined supra-and infraclavicular brachial plexus injuries resulting in impaired hand functions. Advantage of ETSN over end-to-end neurotization is that with ETSN there is no need to sacrifice the surrounding nerves or their fascicles [20]. End-to-side neurorrhaphy was rediscovered in the early 1990s [26].…”

“…This technique is based on the regeneration of an injured recipient nerve through collateral sprouting of axons, one of the most important manifestations of neuroplasticity of an intact donor nerve and has been the subject of many theoretical and experimental studies [27][28][29]. Haninec et al evaluated results of ETSN on a group of patients with an upper brachial injury for axillary or musculocutaneous nerve reconstruction [20]. The patients cohort consisted of 23 patients, the median age of the patients was 25 years (SD = 14.0, range 12-63), and the median time between trauma and surgery was 5 months (SD = 2.0, range 2-9).…”