Phrenic nerve transfer for brachial plexus motor neurotization

Gu, Yajia; Wu, Min-Ming; Yi-Lu, Zhen; Jia-Ao, Zhao; Zhang, Gaomeng; Chen, Desong; Yan, Ji‐Geng; Cheng, Xiaoming

doi:10.1002/micr.1920100407

Cited by 161 publications

(26 citation statements)

References 2 publications

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“…Transfer of the hemicontralateral root of C7 is another good option for brachial plexus injuries with total avulsions [9, 32–34]. The clinical indication is total traumatic damage of the brachial plexus with multiple avulsions and limited nerves available for transfer.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…The contralateral C7 root may be enlarged with the use of a vascular ulnar nerve graft in patients with C8-T1 avulsion injuries and the most commonly used is the median nerve [9]. Neurological deficits have been reported after such a procedure, even in C7 sensory function [9, 32–35]. Another option is to transfer the nerve of the long head of the triceps to the axillary nerve so as to reinnervate the motor function of the deltoid muscle [36].…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Treatment Options for Brachial Plexus Injuries

Sakellariou

Badilas²,

Stavropoulos

et al. 2014

ISRN Orthopedics

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The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed.

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Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Treatment Options for Brachial Plexus Injuries

Sakellariou

Badilas²,

Stavropoulos

et al. 2014

ISRN Orthopedics

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“…A variety of donor nerves exist as a source for neurotization. Some of the more common neurotization sources include the spinal accessory nerve,[12] phrenic nerve,[34] medial pectoral nerve[5] and the intercostal nerves. [67] More recently, the use of a fascicle of a functioning ulnar or median nerve (Oberlin transfer) in patients with intact C8 and T1 has allowed a rapid and powerful return of elbow flexion.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes following nerve transfers in upper brachial plexus injuries

Bhandari

Sadhotra

Bhargava

et al. 2009

Indian J Plast Surg

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Background:Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury.Materials and Methods:We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years) in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations), surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients), and phrenic nerve to suprascapular nerve (1 patient). In 11 patients, axillary nerve was also neurotized using different donors - radial nerve branch to the long head triceps (7 patients), intercostal nerves (2 patients), and phrenic nerve with nerve graft (2 patients). Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients), both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients), spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient), intercostal nerves (3rd, 4th and 5th) to musculocutaneous nerve (4 patients) and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient).Results:Motor and sensory recovery was assessed according to Medical Research Council (MRC) Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50 - 170 degrees). Eight patients scored M4 power in elbow flexion and assessed as excellent results. Good results (M3+) were obtained in seven patients. Five patients had fair results (M2+ to M3).

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“…Biological sealants have long been used in research to provide a scaffold for substances and regrowth of axons and have been employed in neurosurgery for over 20 years without inducing damage to the nervous system [86, 101, 102, 132]. Sealant efficacy is similar or even better when compared to sutures in most of the cases [133–137].…”

Section: Discussionmentioning

confidence: 99%

Multiple uses of fibrin sealant for nervous system treatment following injury and disease

Biscola

Cartarozzi

Ulian-Benitez

et al. 2017

J Venom Anim Toxins Incl Trop Dis

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Lesions to the nervous system often produce hemorrhage and tissue loss that are difficult, if not impossible, to repair. Therefore, scar formation, inflammation and cavitation take place, expanding the lesion epicenter. This significantly worsens the patient conditions and impairment, increasing neuronal loss and glial reaction, which in turn further decreases the chances of a positive outcome. The possibility of using hemostatic substances that also function as a scaffold, such as the fibrin sealant, reduces surgical time and improve postoperative recovery. To date, several studies have demonstrated that human blood derived fibrin sealant produces positive effects in different interventions, becoming an efficient alternative to suturing. To provide an alternative to homologous fibrin sealants, the Center for the Study of Venoms and Venomous Animals (CEVAP, Brazil) has proposed a new bioproduct composed of certified animal components, including a thrombin-like enzyme obtained from snake venom and bubaline fibrinogen. Thus, the present review brings up to date literature assessment on the use of fibrin sealant for nervous system repair and positions the new heterologous bioproduct from CEVAP as an alternative to the commercial counterparts. In this way, clinical and pre-clinical data are discussed in different topics, ranging from central nervous system to peripheral nervous system applications, specifying positive results as well as future enhancements that are necessary for improving the use of fibrin sealant therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40409-017-0103-1) contains supplementary material, which is available to authorized users.

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Phrenic nerve transfer for brachial plexus motor neurotization

Cited by 161 publications

References 2 publications

Treatment Options for Brachial Plexus Injuries

Treatment Options for Brachial Plexus Injuries

Surgical outcomes following nerve transfers in upper brachial plexus injuries

Multiple uses of fibrin sealant for nervous system treatment following injury and disease

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