Full-Length Phrenic Nerve Transfer by Means of Video-Assisted Thoracic Surgery in Treating Brachial Plexus Avulsion Injury

Xu, Wendong; Gu, Yajia; Xu, Jianguang; Tan, Lijie

doi:10.1097/00006534-200207000-00018

Cited by 74 publications

(43 citation statements)

References 5 publications

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“…Since the adoption of phrenic transfer by Gu et al [8], many patients have recovered elbow flexion, which would otherwise remain paralyzed. Recently, Xu et al [27] harvested a longer phrenic nerve by using video-assisted thoracic surgery. This technique allows direct nerve transfer to the biceps.…”

Section: Discussionmentioning

confidence: 99%

Restoration of Elbow Flexion by Transfer of the Phrenic Nerve to Musculocutaneous Nerve after Brachial Plexus Injuries

Ricardo¹

2007

Hand (New York, N,Y.)

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Traumatic brachial plexus injuries are a devastating injury that results in partial or total denervation of the muscles of the upper extremity. Treatment options that include neurolysis, nerve grafting, or neurotization (nerve transfer) has become an important procedure in the restoration of function in patients with irreparable preganglionic lesions. Restoration of elbow flexion is the primary goal in treating patients with severe brachial plexus injuries. Nerve transfers are used when spinal roots are avulsed, and proximal stumps are not available. In the present study, we analyze the results obtained in 20 patients treated with phrenic-musculocutaneous nerve transfer to restore elbow flexion after brachial plexus injuries. A consecutive series of 25 adult patients (21 men and 4 women) with a brachial plexus traction/crush lesion were treated with phrenicmusculocutaneous nerve transfer, but only 20 patients (18 men and 2 women) were followed and evaluated for at least 2 years postoperatively. All patients had been referred from other institutions. At the initial evaluation, eight patients received a diagnosis of C5-6 brachial plexus nerve injury, and in the other 12 patients, a complete brachial plexus injury was identified. Reconstruction was undertaken if no clinical or electrical evidence of biceps muscle function was seen by 3 months post injury. Functional elbow flexion was obtained in the majority of cases by phrenic-musculocutaneous nerve transfer (14/20, 70%). At the final follow-up evaluation, elbow flexion strength was a Medical Research Council Grade 5 in two patients, Grade 4 in four patients, Grade 3 in eight patients, and Grade 2 or less in six patients. Transfer involving the phrenic nerve to restore elbow flexion seems to be an appropriate approach for the treatment of brachial plexus root avulsion. Traumatic brachial plexus injury is a devastating injury that result in partial or total denervation of the muscles of the upper extremity. Treatment options include neurolysis, nerve grafting, or neurotization (nerve transfer). Neurotization is the transfer of a functional but less important nerve to a denervated more important nerve. It has become an important procedure in the restoration of function in patients with irreparable preganglionic lesions. Restoration of elbow flexion is the primary goal in treating patients with severe brachial plexus injuries. Nerve transfers are used when spinal roots are avulsed, and proximal stumps are not available. Newer extraplexal sources include the ipsilateral phrenic nerve as reported by Gu et al. (Chin Med J 103:267-270, 1990) and contralateral C7 as reported by Gu et al. (J Hand Surg [Br] 17(B):518-521, 1992) and Songcharoen et al. (J Hand Surg [Am] 26(A): [1058][1059][1060][1061][1062][1063][1064] 2001). These nerve transfers have been introduced to expand on the limited donors. The phrenic nerve and its anatomic position directly within the surgical field makes it a tempting source for nerve transfer. Although not always, in cases of comple...

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Section: Discussionmentioning

confidence: 99%

Restoration of Elbow Flexion by Transfer of the Phrenic Nerve to Musculocutaneous Nerve after Brachial Plexus Injuries

Ricardo¹

2007

Hand (New York, N,Y.)

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“…Peripheral nerve transfer has been used for surgical treatment of brachial plexus injury for many years [2,11,13,38]. In particular, the "standard" method of Table 2.…”

Section: Discussionmentioning

confidence: 99%

“…To do this, peripheral nerve specimens (distal part of the transferred nerve point) were removed. Specimens were then embedded in paraffin, cut transversely, and stained using the Masson-Trichrome method [37].…”

Section: Control Group (Ac To Ac N = 4)mentioning

confidence: 99%

Morphological and Electromyogram Analysis for the Spinal Accessory Nerve Transfer to the Suprascapular Nerve in Rats

Jing¹,

Ogino²,

Hitomi³

2011

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For many years, nerve transfer has been commonly used as a treatment option following peripheral nerve injury, although the precise mechanism underlying successful nerve transfer is not yet clear. We developed an animal model to investigate the mechanism underlying nerve transfer between branches of the spinal accessory nerve (Ac) and suprascapular nerve (Ss) in rats, so that we could observe changes in the number of motor neurons, investigate the 3-dimensional localization of neurons in the anterior horn of the spinal cord, and perform an electromyogram (EMG) of the supraspinatus muscle before and after nerve transfer treatment. The present experiment showed a clear reduction in the number of γ motor neurons. The distributional portion of motor neurons following nerve transfer was mainly within the neuron column innervating the trapezius. Some neurons innervating the supraspinatus muscle also survived post-transfer. Compared with the non-operated group, the EMG restoration rate of the supraspinatus muscle following nerve transfer was 60% in the experimental group and 80% in a surgical control group. Following nerve transfer, there was a distinct reduction in the number of γ motor neurons. Therefore, γ motor neurons may have important effects on the recovery of muscular strength following nerve transfer. Moreover, because the neurons located in regions innervating either the trapezius or supraspinatus muscle were labeled after Ac transfer to Ss, we also suggest that indistinct axon regeneration mechanisms exist in the spinal cord following peripheral nerve transfer.

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“…It has been used in C 5 -T 1 nerve root brachial plexus avulsion to re-innervate the MCN [106], the median nerve (MN) [129] or the RAN [46]. Unless its whole intra-thoracic segment is harvested, a nerve graft is needed [129].…”

Section: Phrenic Nerve Transfersmentioning

confidence: 99%

“…Unless its whole intra-thoracic segment is harvested, a nerve graft is needed [129]. The clinical results are acceptable provided there is no other choice.…”

Section: Phrenic Nerve Transfersmentioning

confidence: 99%

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Vanaclocha‐Vanaclocha¹,

Ortiz-Criado²,

NievesSáiz-Sapena³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Successful re-innervation of proximal limb peripheral nerve injuries is rare. Axons regenerate at ~1 mm/day, reaching hand muscles by 24 months, finding them atrophied and fibrosed. Peripheral nerve injury repair is often delayed waiting for spontaneous recovery. This waiting time should not be longer than 6 months as after 18 months reinnervation will not achieve effective muscular function. When spontaneous recovery is impossible, referral too late or damage too severe, other options like a transfer from a nearby healthy nerve to the injured one must be considered. They are very successful, and the deficit in the donor site is usually minimal. The most common nerve transfers are a branch of the spinal nerve to the trapezius muscle to the suprascapular nerve, a branch of the long head of the triceps to the axillary nerve, a fascicle of the ulnar nerve to the motor branch of the biceps muscle, two branches of the median nerve to the posterior interosseous nerve and the anterior interosseous nerve to the ulnar nerve. There are many more options that can suit particular cases. Introduced in brachial plexus injury repair, they are now also applied to lower limb, to stroke and to some spinal cord injuries.

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Full-Length Phrenic Nerve Transfer by Means of Video-Assisted Thoracic Surgery in Treating Brachial Plexus Avulsion Injury

Cited by 74 publications

References 5 publications

Restoration of Elbow Flexion by Transfer of the Phrenic Nerve to Musculocutaneous Nerve after Brachial Plexus Injuries

Restoration of Elbow Flexion by Transfer of the Phrenic Nerve to Musculocutaneous Nerve after Brachial Plexus Injuries

Morphological and Electromyogram Analysis for the Spinal Accessory Nerve Transfer to the Suprascapular Nerve in Rats

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

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