Nerve transfer in brachial plexus traction injuries

Samardžić, Miroslav; Grujičić, Milorad; Rasulic, G Lukas; Bacetić, Dragoljub; Miličić, Biljana

doi:10.2298/vsp0305539s

Cited by 34 publications

(50 citation statements)

References 11 publications

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“…For instance, transfer of the medial pectoral nerve (a shoulder adductor) to the axillary nerve (a shoulder abductor) is recognized as a successful technique. 48,51,52 Similarly, Tung and Mackinnon, 41,60 among others, successfully used distal nerve transfers for reinnervation of antagonistic functions. They selected nerve branches of the median nerve to reinnervate injured antagonistic distal radial nerve branches and likewise used radial nerve branches to innervate antagonist median nerve-dependent muscles.…”

Section: The Problem Of Combined Agonist and Antagonist Muscle Innervmentioning

confidence: 99%

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Socolovsky

Malessy

Lopez

et al. 2017

FOC

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OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.

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Section: The Problem Of Combined Agonist and Antagonist Muscle Innervmentioning

confidence: 99%

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Socolovsky

Malessy

Lopez

et al. 2017

FOC

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“…The MPN is a motor nerve derived from the medial cord of the brachial plexus, formed from the anterior division of the lower trunk [12,18]. It is normal in upper plexus injuries.…”

Section: Discussionmentioning

confidence: 99%

Medial Pectoral Nerve to Axillary Nerve Neurotization following Traumatic Brachial Plexus Injuries: Indications and Clinical Outcomes

Ray

Murphy

Santosa

et al. 2011

Hand (New York, N,Y.)

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Introduction The medial pectoral nerve (MPN) represents a viable donor nerve for neurotization procedures for restoration of shoulder function following upper trunk brachial plexus injuries. Materials and MethodsWe report an eight-case series, single-surgeon experience of patients with upper trunk brachial plexus injuries who underwent MPN to axillary nerve (AXN) transfer from 2001-2007 for shoulder stability and abduction. Results The mean patient age was 31.5 (range, 19-51 years). The mean follow-up for all patients was 22.25±7.4 months. Surgery was performed at a mean of 5.8±2.9 months postinjury. On initial evaluation, all eight patients had no deltoid function (M0). Of the eight patients examined postoperatively, we observed excellent recovery in four, good recovery in two, fair recovery in one, and poor functional recovery in the remaining patient. Discussion MPN to AXN neurotization is a valid surgical option in the restoration of shoulder stability and shoulder abduction following trauma-related upper trunk brachial plexus injury.

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“…This makes it difficult to compare the results of the applied transfers; however, accessory nerve-musculocutaneous nerve transfer can result in MRC Grade 3 or higher in between 50 and 75% of the patients. 27,32 This indicates that the accessory nerve is a useful donor for nerve transfer, at least for elbow flexion. Intrinsic qualities related to the intercostal nerve and accessory nerve donor nerves play a role in restoring functional outcome for the regain of elbow flexion and shoulder function.…”

Section: Elbow Flexionmentioning

confidence: 99%

Evaluation of suprascapular nerve neurotization after nerve grafting or transfer in the treatment of brachial plexus traction lesions

Malessy¹,

Ruiter²,

Boer³

et al. 2004

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Object The aim of this retrospective study was to evaluate the restoration of shoulder function by means of supra-scapular nerve neurotization in adult patients with proximal C-5 and C-6 lesions due to a severe brachial plexus traction injury (BPTI). The primary goal of brachial plexus reconstructive surgery was to restore the biceps muscle function and, secondarily, to reanimate shoulder function. Methods Suprascapular nerve neurotization was performed by grafting the C-5 nerve in 24 patients and by accessory or hypoglossal nerve transfer in 29 patients. Additional neurotization involving the axillary nerve could be performed in 18 patients. Postoperative needle electromyography studies of the supraspinatus, infraspinatus, and deltoid muscles showed signs of reinnervation in most patients; however, active glenohumeral shoulder function recovery was poor. In nine (17%) of 53 patients supraspinatus muscle strength was Medical Research Council (MRC) Grade 3 or 4 and in four (8%) infraspinatus muscle power was Grade 3 or 4. In 18 patients in whom deltoid muscle reinnervation was attempted, MRC Grade 3 or 4 function was demonstrated in two (11%). In the overall group, eight patients (15%) exhibited glenohumeral abduction with a mean of 44 ± 17° (standard deviation [SD]) (median 45°) and four patients (8%) exhibited glenohumeral exorotation with a mean of 48 ± 24° (SD) (median 53°). In only three patients (6%) were both functions regained. Conclusions The reanimation of shoulder function in patients with proximal C-5 and C-6 BPTIs following supra-scapular nerve neurotization is disappointingly low.

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Nerve transfer in brachial plexus traction injuries

Abstract: Our findings suggest that nerve transfer of collateral branches, where possible, (such as in cases with upper or extended upper brachial plexus palsy) might be a method of choice, offering better results and quality of recovery.

Cited by 34 publications

References 11 publications

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Medial Pectoral Nerve to Axillary Nerve Neurotization following Traumatic Brachial Plexus Injuries: Indications and Clinical Outcomes

Evaluation of suprascapular nerve neurotization after nerve grafting or transfer in the treatment of brachial plexus traction lesions

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