Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy

Kawabata, Hidehiko; Shibata, Toru; Matsui, Yoshito; Yasui, Natsuo

doi:10.3171/jns.2001.94.3.0386

Cited by 92 publications

(71 citation statements)

References 28 publications

(23 reference statements)

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“…Many publications in the medical literature detail successful means of treatment of patients of all ages with injuries to the brachial plexus, most commonly interposition nerve grafting, neurotization utilizing the intercostal nerves, and, more recently, the Oberlin procedure. 5,11,16,18,25,26,28,29,33,34,36,37 Experienced peripheral nerve surgeons are required to adapt on a case-by-case basis based on preoperative recovery patterns and intraoperative observations (for example, length of available nerves for direct neurotization and availability of proximal roots for grafting).…”

Section: Discussionmentioning

confidence: 99%

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Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience

Wellons¹,

Tubbs

Pugh³

et al. 2009

PED

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Object Medial pectoral nerve (MPN) to musculocutaneous nerve (MCN) neurotization for recovery of elbow flexion by biceps reinnervation is a valid option following traumatic injury to the upper brachial plexus. A major criticism of the application of this technique in infants is the smaller size of the MPN and mismatch of viable axons. We describe our institutional experience utilizing this procedure and critically examine functional outcomes. Methods Office charts and hospital records of children from over an 11-year period beginning January 1997 were reviewed. Of the 53 children of various ages undergoing brachial plexus exploration for traumatic injury of any nature, 20 underwent MPN to MCN neurotization as a part of an overall procedure in the first year of life to treat birth-related brachial plexus palsy and had at least 9 months' follow-up. Medial pectoral nerve to MCN neurotization was chosen if the results of clinical examination and intraoperative electrophysiological evidence were consistent with medial cord function. Functional recovery was defined as the ability of the child to bring their hand to their mouth. Results Sixteen patients (80%) gained functional recovery. The median age at surgery was 7 months. Median time to first clinic visit documenting recovery was 11.5 months and median overall follow up was 21.5 months. Preoperative hand function was a useful predictor of recovery of elbow flexion. Conclusions Medial pectoral nerve to MCN neurotization is a valid surgical option for the reinnervation of the biceps muscle for birth-related brachial plexus palsy when the hand is functional preoperatively. Useful elbow flexion can be expected in the majority of these children.

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Section: Discussionmentioning

confidence: 99%

“…16,18,25,26,28,31,33 We report a 2-surgeon series at a single institution over 11 years in which MPN to MCN neurotization was performed in infants who had no return of elbow flexion following a birth-related injury.…”

mentioning

confidence: 99%

Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience

Wellons¹,

Tubbs

Pugh³

et al. 2009

PED

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“…16,17,[22][23][24][25][26][27] The decision for surgery is generally taken in a time window ranging from 3 to 9 months, i.e. long before an end-stage of spontaneous recovery is reached.…”

Section: Assessment Of End-stagementioning

confidence: 99%

“…19,20 Methods of repair include nerve grafting after resection of the neuroma and nerve transfer in the case of root avulsion. 15,[21][22][23][24][25] Results achieved by these surgical approaches are claimed to be superior to the outcome in conservatively treated patients with equally severe lesions. 15,[26][27][28] However, this comparison relies on historical controls; 29 no randomized study has been performed.…”

mentioning

confidence: 99%

Natural history of obstetric brachial plexus palsy: a systematic review

Pondaag

Malessy

Dijk³

et al. 2004

Develop Med Child Neuro

308

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“…Subsequently, several authors have reported their experience with intercostal nerve transfer [4,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] . In order to restore maximum function of the arm, as many intercostal nerves as possible are harvested and transferred.…”

Section: Discussionmentioning

confidence: 99%

Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

Lykissas

Kostas-Agnantis²,

Korompilias³

et al. 2013

WJO

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Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles (i.e. , latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration.

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Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy

Abstract: Neurotization of the MCN by surgically connecting ICNs is a safe, reliable, and effective procedure for reconstruction of the brachial plexus in patients suffering from birth-related palsy.

Cited by 92 publications

References 28 publications

Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience

Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience

Natural history of obstetric brachial plexus palsy: a systematic review

Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

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