Optimal Axon Counts for Brachial Plexus Nerve Transfers to Restore Elbow Flexion

Schreiber, Joseph J.; Byun, David J.; Khair, M. Michael; Rosenblatt, Lauren; Lee, Steve K.; Wolfe, Scott W.

doi:10.1097/prs.0000000000000795

Cited by 95 publications

(89 citation statements)

References 53 publications

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“…All factors necessary for clinical efficacy are present: the diameter of the two nerves matches perfectly, a pure motor nerve is transferred to another pure motor nerve, and the nerve is sutured close to the muscle, allowing faster motor recovery [4]. The number of nerve fibers comprised by the rhomboid nerve was not calculated; this data could have given some additional indication of the effectiveness of the reinnervation.…”

Section: Discussionmentioning

confidence: 99%

“…For pure motor nerves, nerve diameter is correlated to the number of fascicles [4]. In addition, if the nerve surgery were to fail, direct transfer of the trapezius muscle is still possible, particularly to restore external rotation [10].…”

Section: Discussionmentioning

confidence: 99%

“…If the roots are ruptured, one of the most used and most reliable nerve transfers remains that of the external branch of the spinal accessory nerve to the suprascapular nerve; this restores abduction and/or external rotation of the shoulder [2]. However, the difference in diameter between the spinal accessory and suprascapular nerves can reduce the quality of supraspinatus and infraspinatus muscle reinnervation [3,4]. Moreover, this transfer partially sacrifices trapezius function, a muscle fundamental to shoulder function [5].…”

Section: Introductionmentioning

confidence: 97%

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Transfer of the rhomboid nerve to the suprascapular nerve: An anatomical feasibility study

Goubier¹,

Teboul²

2015

Chirurgie de la Main

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Transfer of the rhomboid nerve to the suprascapular nerve: An anatomical feasibility study

Goubier¹,

Teboul²

2015

Chirurgie de la Main

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“…Important for functional outcomes is the application of nerve transfers that take synergistic function and axon ratio between donor and recipient into account. Correct axon ratio is crucial for the successful reinnervation of a high number of muscle fibers and thus muscle functionality [16]. The synergistic function between donor and recipient facilitates cortical recognition of the new innervation pattern by the patient [17].…”

Section: Introductionmentioning

confidence: 99%

Experimental nerve transfer model in the rat forelimb

et al. 2016

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SummaryBackgroundNerve transfers are a powerful tool in extremity reconstruction, but the neurophysiological effects have not been adequately investigated. As 81 % of nerve injuries and most nerve transfers occur in the upper extremity with its own neurophysiological properties, the standard rat hindlimb model may not be optimal in this paradigm. Here we present an experimental rat forelimb model to investigate nerve transfers.MethodsIn ten male Sprague-Dawley rats, the ulnar nerve was transferred to the motor branch of long head of the biceps. Sham surgery was performed in five animals (exposure/closure). After 12 weeks of regeneration, muscle force and Bertelli test were performed and evaluated.ResultsThe nerve transfer successfully reinnervated the long head of the biceps in all animals, as indicated by muscle force and behavioral outcome. No aberrant reinnervation occurred from the original motor source. Muscle force was 2,68 N ± 0.35 for the nerve transfer group and 2,85 N ± 0.39 for the sham group, which was not statically different (p = 0.436). The procedure led to minor functional deficits due to the loss of ulnar nerve function; this, however, could not be quantified with any of the presented measures.ConclusionThe above-described rat model demonstrated a constant anatomy, suitable for nerve transfers that are accessible to standard neuromuscular analyses and behavioral testing. This model allows the study of both neurophysiologic properties and cognitive motor function after nerve transfers in the upper extremity.

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“…A critical predictor of the outcome of transferring a nerve is the functioning motor axonal complement within the donor nerve. 45 To date, neurophysiologists have tended to rely on subjective quantification of the electromyographic interference pattern (IP). However, quantitative neurophysiology has found a clinical home in this context to accompany its established research utility.…”

Section: Clinical Assessmentmentioning

confidence: 99%

A neurophysiological approach to nerve transfer to restore upper limb function in cervical spinal cord injury

Mandeville¹,

Brown

Sheean³

2017

Neurosurgical Focus

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A successful nerve transfer surgery can provide a wealth of benefits to a patient with cervical spinal cord injury. The process of surgical decision making ideally uses all pertinent information to produce the best functional outcome. Reliance on clinical examination and imaging studies alone can miss valuable information on the state of spinal cord health. In this regard, neurophysiological evaluation has the potential to effectively gauge the neurological status of even select pools of anterior horn cells and their axons to small nerve branches in question to determine the potential efficacy of their use in a transfer. If available preoperatively, knowledge gained from such an evaluation could significantly alter the reconstructive surgical plan and avoid poor results. The authors describe their institution’s approach to the assessment of patients with cervical spinal cord injury who are being considered for nerve transfer surgery in both the acute and chronic setting and broadly review the neurophysiological techniques used.

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Optimal Axon Counts for Brachial Plexus Nerve Transfers to Restore Elbow Flexion

Cited by 95 publications

References 53 publications

Transfer of the rhomboid nerve to the suprascapular nerve: An anatomical feasibility study

Transfer of the rhomboid nerve to the suprascapular nerve: An anatomical feasibility study

Experimental nerve transfer model in the rat forelimb

A neurophysiological approach to nerve transfer to restore upper limb function in cervical spinal cord injury

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