Nerve transfers for brachial plexus injuries
Section snippets
Spinal accessory nerve
The spinal accessory nerve (cranial nerve XI) innervates the sternocleidomastoid and trapezius muscles and has approximately 1,700 myelinated motor fibers.2 When harvested, it can be approached through the same transverse supraclavicular incision used to expose the supraclavicular brachial plexus. At the lateral margin of the wound, the spinal accessory nerve is identified several centimeters above the clavicle on the anterior surface of the trapezius (Fig. 1). A nerve stimulator is helpful in
Conclusions
Nerve transfers are being used increasingly by brachial plexus surgeons in different situations and combinations to achieve broader and better function. Their use in cases of preganglionic injury allows recovery in otherwise “irreparable” lesions. Nerve transfers can also be used instead of nerve grafting for postganglionic injuries, or to power free functioning muscle transfers. Nerve transfers have allowed a more rapid and reliable return of function than other existing techniques. Even in
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Cited by (14)
Postoperative motor deficits following elbow flexion reanimation by nerve transfer
2018, Hand Surgery and RehabilitationCitation Excerpt :Depending on the type of harvest, nerve transfers may be divided in two categories: either a distal motor branch of a functioning muscle is harvested in its entirety (i.e., end-to-end transfer), or motor fascicles from a proximal composite nerve are selected with intraoperative neurostimulation (i.e., side-to-end transfer). They are sutured end-to-end to the affected target in both cases (i.e., end-to-end fascicular sutures) [5]. While postoperative deficits are inevitable in the territory of the selected branch in end-to-end transfers, most authors consider that the plexiform nature of proximal nerves seems to circumvent such shortcomings in side-to-end transfers [3,6,7].
Surgical Exposures for Nerves of the Upper Limbs
2015, Nerves and Nerve Injuries: Pain, Treatment, Injury, Disease and Future Directions: Vol 2Peripheral nerve injuries: Advancing the field through research, collaboration, and education
2014, Journal of Hand SurgeryPeripheral nerve surgery. Primer for the imagers
2014, Neuroimaging Clinics of North AmericaCitation Excerpt :In the same clinical setting, extraplexal donor nerves include the spinal accessory, intercostal, and phrenic nerves. In the context of complete plexus avulsion, the contralateral C7 nerve root may serve as a contributing element in neurotization.11 The type of nerve transfer used must be selected based on the specific injury and donor nerve function.
Management of Adult Brachial Plexus Injuries
2012, Schmidek and Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results: Sixth Edition