Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Vanaclocha‐Vanaclocha, Vicente; Ortiz-Criado, José María; NievesSáiz-Sapena,; Vanaclocha, Nieves

doi:10.5772/67948

Cited by 3 publications

(4 citation statements)

References 173 publications

(259 reference statements)

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“…Complete transection of the phrenic nerve from an acute iatrogenic or traumatic event a rare reported occurrence given its somewhat inaccessible location in both the cervical and thoracic regions. [23][24][25] The nerve is deep to the prevertebral fascia and lateral to the carotid sheath in the neck, and medial to the lung within the pericardial fat along the mediastinal and thoracic course. More commonly, the phrenic nerve and the dominant nerve root contributions (C4-5) are susceptible to compression from adjacent fibrous, muscular, and vascular adhesions, a process not dissimilar to generally recognized compression neuropathies of the brachial plexus and upper extremity.…”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiology of phrenic neuropathy resulting in diaphragmatic paralysis varies based upon the mechanism of injury. Complete transection of the phrenic nerve from an acute iatrogenic or traumatic event is a rare reported occurrence given its somewhat inaccessible location in both the cervical and thoracic regions 23–25 . The nerve is deep to the prevertebral fascia and lateral to the carotid sheath in the neck, and medial to the lung within the pericardial fat along the mediastinal and thoracic course.…”

Section: Discussionmentioning

confidence: 99%

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Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis

et al. 2021

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Diaphragmatic paralysis due to phrenic nerve injury may cause orthopnea, exertional dyspnea, and sleep-disordered breathing. Phrenic nerve reconstruction may relieve symptoms and improve respiratory function. A retrospective review of 400 consecutive patients undergoing phrenic nerve reconstruction for diaphragmatic paralysis at 2 tertiary treatment centers was performed between 2007 and 2019. Symptomatic patients were identified, and the diagnosis was confirmed on radiographic evaluations. Assessment parameters included pulmonary spirometry (forced expiratory volume in 1 second and FVC), maximal inspiratory pressure, compound muscle action potentials, diaphragm thickness, chest fluoroscopy, and Short Form 36 Health Survey Questionnaire (SF-36) survey. There were 81 females and 319 males with an average age of 54 years (range, 19–79 years). The mean duration from diagnosis to surgery was 29 months (range, 1–320 months). The most common etiologies were acute or chronic injury (29%), interscalene nerve block (17%), and cardiothoracic surgery (15%). The mean improvements in forced expiratory volume in 1 second and FVC at 1 year were 10% (P < 0.01) and 8% (P < 0.05), respectively. At 2-year follow-up, the corresponding values were 22% (P < 0.05) and 18% (P < 0.05), respectively. Improvement on chest fluoroscopy was demonstrated in 63% and 71% of patients at 1 and 2-year follow-up, respectively. There was a 20% (P < 0.01) improvement in maximal inspiratory pressure, and compound muscle action potentials increased by 82% (P < 0.001). Diaphragm thickness demonstrated a 27% (P < 0.01) increase, and SF-36 revealed a 59% (P < 0.001) improvement in physical functioning. Symptomatic diaphragmatic paralysis should be considered for surgical treatment. Phrenic nerve reconstruction can achieve symptomatic relief and improve respiratory function. Increasing spirometry and improvements on Sniff from 1 to 2 years support incremental recovery with longer follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis

et al. 2021

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“…e PT branch is not very recommended as a donor for reinnervation because pronation is essential for many daily living activities and because this muscle can be used for a tendon transfer in case the nerve transfer is unsuccessful. [31] Transfer: Supinator motor branch to PIN After the transfer of brachialis to the AIN, the rotation and pronation of the forearm is performed. A longitudinal incision was performed on the proximal third of the dorsal forearm.…”

Section: Surgical Techniquementioning

confidence: 99%

“…To try to recover the ulnar motor function, AIN to ulnar transfer was performed in a second surgical time, between 4 and 6 months later. e surgical technique proposed by Brown et al was performed, associated with a Taleisnik incision [31] (7 mm to the ulnar side of the thenar crease) to access the Guyon's canal. In this case, AIN motor branch related to innervation of the pronator quadratus was used as a motor component of the ulnar nerve [8] [Figure 3].…”

Section: Transfer: Ain To Ulnarmentioning

confidence: 99%

Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

Souza

Bernardino

Cézar

et al. 2020

Surgical Neurology International

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Background: Distal nerve transfers are an innovative modality for the treatment of C8-T1 brachial plexus lesions. The purpose of this case series is to report the authors’ results with hand restoration function by nerve transfer in patients with lower brachial plexus injury. Methods: Three consecutive nerve transfers were performed in a series of 11 patients to restore hand function after injury to the lower brachial plexus: brachialis motor branch to anterior interosseous nerve (AIN) and supinator branch to the posterior interosseous nerve (PIN) in a first surgical procedure, and AIN to pronator quadratus branch of ulnar nerve between 4 and 6 months later. Results: In all, 11 male patients underwent 33 surgical procedures. Time between brachial plexus injury and surgery was a mean of 11 months (range 4–13 months). Postoperative follow-up ranged from 12 to 24 months. We observed recovery of M3 or better finger flexion strength (AIN) and wrist extension (PIN) in 8 of the 11 surgically treated upper limbs. These patients recovered full thumb and finger extension between 6 and 12 months of surgery, without significant loss of donor function. Conclusion: Nerve transfers represent a way of restoring volitional control of upper extremity function in patients with C8-T1 brachial plexus injury.

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Motor nerve transfers for restoration of upper arm function in adult brachial plexus injuries

Samardžić

Rasulić²,

Stanković³

2022

Serb J Neurosurg

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Introduction. Nerve transfers are the only surgical option in reconstruction of directly irreparable injuries of the brachial plexus. In the recent years there has been a trend toward the increased use of nerve transfers with introduction of many new methods and novel indications. Patients with total brachial plexus palsy generally have a poor outcome because of a very limited number of donor nerves. On the contrary, patients with partial injuries involving the C5, C6 and sometimes C7 spinal nerves have a remarquable outcome in a large majority of cases. In both situations , restoration of elbow flexion and shoulder functions are the main priorities. It should be emphasized, that in the cases with upper brachial plexus palsy this could be a complete functional recovery. The intention of this review article is a detailed survey on basics of nerve transfers with the comments concerning their advantages, problems and controversies. Analysis is documented with reported outcomes in the literature dealing with the most common methods of nerve transfer.Methods. PubMed/Medline databases were searched for English language basic articles concernig nerve transfers and series of adult patients who had nerve transfers for functional restoration of the upper arm nerves, performed within one year after injury and with minimum follow-up of one year. Finally, we selected 70 articles . Furthermore, literature search for outcome analysis was limited to the articles published after 1990 that included 45 systematic reviews and meta-analyses of the most common nerve transfers ( intercostal, spinal accessory, fascicular and collateral branches of the brachial plexus ). Analysis of clinical outcomes was based on Medical Research Council (MRC) grading system for muscle strenght, and grades M3 or more were considered as useful functional recovery.Results. Generally, intraplexal nerve transfers resulted with higher rate and better quality of recovery, comparing to the extraspinal transfers. Grades M3 or more were obtained in 72% of the intercostal and 73% of the spinal accessory nerve transfers for restoration of elbow flexion, and in 56% vs. 98% of transfers for restoration of shoulder function. Among intraplexal nerve transfers , elbow flexion was restored in 84% to 91% of the medial pectoral, 100% of the thoracodorsal and 94% to 100% of the single or double fascicular nerve transfers. Shoulder function was restored in 81,8% of the medial pectoral, 86% to 93% of the thoracodorsal and 100% of the triceps branch nerve transfers. Dual nerve transfers, meanning simultaneous reinnervation of the suprascapular and axillary nerves, resulted with 100% rate of recovery.Conclusion. Double fascicular transfer for restoration of elbow flexion and dual nerve transfer for restoration of shoulder function resulted with significantly better results than the other transfers, especially regarding the quality of recovery, meanning representation of grades M4 and M5 among recoveries. Medial pectoral and thoracodorsal nerve transfers proved as a good alternative for restoration of both functions.

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Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Cited by 3 publications

References 173 publications

Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis

Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis

Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

Motor nerve transfers for restoration of upper arm function in adult brachial plexus injuries

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