Nerve Graft and Nerve Transfer

The treatment of patients with prolonged denervation from a posterior cord brachial plexus injury is challenging and no management guidelines exist to follow. The authors describe the case of a 26-year-old man who presented to our clinic for treatment 11 months after suffering a high-energy injury to the posterior cord of the brachial plexus. A combined 9-cm proximal cable nerve graft procedure and a pronator branch to the posterior interosseous nerve transfer were performed. Satisfactory deltoid, triceps, wrist, and finger extensor recovery was noted 3 years after surgery. Patients with prolonged denervation from posterior cord injuries can be successfully treated with a combination of a proximal nerve graft and a distal nerve transfer.

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Future Perspectives in the Management of Nerve Injuries

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1639353 ◽

2018 ◽

Vol 34 (09) ◽

pp. 672-674 ◽

Cited By ~ 14

Author(s):

Susan Mackinnon

Keyword(s):

Brachial Plexus ◽

Nerve Repair ◽

Nerve Transfer ◽

Functional Results ◽

White Paper ◽

Nerve Graft ◽

Nerve Injuries ◽

Nerve Grafts ◽

Nerve Transfers ◽

Reconstructive Microsurgery

Aim The author presents a solicited “white paper” outlining her perspective on the role of nerve transfers in the management of nerve injuries. Methods PubMed/MEDLINE and EMBASE databases were evaluated to compare nerve graft and nerve transfer. An evaluation of the scientific literature by review of index articles was also performed to compare the number of overall clinical publications of nerve repair, nerve graft, and nerve transfer. Finally, a survey regarding the prevalence of nerve transfer surgery was administrated to the World Society of Reconstructive Microsurgery (WSRM) results. Results Both nerve graft and transfer can generate functional results and the relative success of graft versus transfer depended on the function to be restored and the specific transfers used. Beginning in the early 1990s, there has been a rapid increase from baseline of nerve transfer publications such that clinical nerve transfer publication now exceeds those of nerve repair or nerve graft. Sixty-two responses were received from WSRM membership. These surgeons reported their frequency of “usually or always using nerve transfers for repairing brachial plexus injuries as 68%, radial nerves as 27%, median as 25%, and ulnar as 33%. They reported using nerve transfers” sometimes for brachial plexus 18%, radial nerve 30%, median nerve 34%, ulnar nerve 35%. Conclusion Taken together this evidence suggests that nerve transfers do offer an alternative technique along with tendon transfers, nerve repair, and nerve grafts.

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Hypoglossal-Facial Side-to-End Neurorrhaphy With Concomitant Masseteric-Zygomatic Nerve Branch Coaptation and Muscle Transfer for Facial Reanimation: Technique and Case Report

Operative Neurosurgery ◽

10.1093/ons/opaa128 ◽

2020 ◽

Vol 19 (3) ◽

pp. E230-E235

Author(s):

Nobutaka Yoshioka

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Mass Movement ◽

Nerve Transfer ◽

Nerve Graft ◽

Gracilis Muscle ◽

Muscle Transfer ◽

Nerve Branch ◽

Facial Reanimation ◽

Healthy Side

Abstract BACKGROUND Hypoglossal-facial direct side-to-end neurorrhaphy has become widely used for facial reanimation in patients with irreversible facial nerve damage. Although this procedure achieves good restoration of facial function, it has disadvantages such as mass movement and lack of spontaneity. OBJECTIVE To present a new facial reanimation technique using hypoglossal-facial direct side-to-end neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and secondary muscle transfer to reduce mass movement and achieve a spontaneous smile in patients with facial paralysis. METHODS This article describes a novel facial reanimation technique that employs hypoglossal and masseteric nerve transfer combined with secondary vascularized functional gracilis muscle transfer. RESULTS Details of the technique are reported in a patient with complete facial paralysis after brain surgery. The hypoglossal nerve was partially served and connected to the mastoid segment of the facial nerve by side-to-end anastomosis to restore facial symmetry. A nerve supplying the masseter muscle was coapted with a zygomatic branch by end-to-end anastomosis to restore voluntary movement of the oral commissure, as well as to assist with eye closure. A cross face sural nerve graft was connected to zygomatic branches on the healthy side. In the second stage, a vascularized functional gracilis muscle graft was transplanted using the cross face nerve graft as the donor nerve to restore a natural smile. CONCLUSION Hypoglossal-facial neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and muscle transfer is an alternative facial reanimation technique that reduces mass movement and achieves a natural smile.

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Update on corneal neurotisation

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312104 ◽

2018 ◽

Vol 103 (1) ◽

pp. 26-35 ◽

Cited By ~ 11

Author(s):

Raman Malhotra ◽

Mohamed Shafik Elalfy ◽

Ruben Kannan ◽

Charles Nduka ◽

Samer Hamada

Keyword(s):

Healthy Donor ◽

Nerve Transfer ◽

Nerve Graft ◽

Nerve Growth ◽

Detailed Review ◽

Corneal Sensation ◽

Trophic Function ◽

Direct Nerve ◽

Neurotrophic Keratopathy

Corneal neurotisation describes surgical restoration of nerve growth into the cornea to restore corneal sensation and trophic function. It represents an exciting and effective emerging treatment for neurotrophic keratopathy. Techniques described to date involve either direct nerve transfer or an interpositional nerve graft coapted to a healthy donor nerve. We review the experience to date with particular emphasis on a detailed review of techniques, outcomes and current thoughts.

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Recovery of shoulder abduction in traumatic brachial plexus palsy: a systematic review and meta-analysis of nerve transfer versus nerve graft

Neurosurgical Review ◽

10.1007/s10143-019-01100-9 ◽

2019 ◽

Vol 43 (3) ◽

pp. 951-956

Author(s):

Nathan Hardcastle ◽

Pavlos Texakalidis ◽

Purva Nagarajan ◽

Muhibullah S. Tora ◽

Nicholas M. Boulis

Keyword(s):

Systematic Review ◽

Brachial Plexus ◽

Meta Analysis ◽

Nerve Transfer ◽

Nerve Graft ◽

Shoulder Abduction ◽

Brachial Plexus Palsy

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An Experimental Study of Contralateral C7 Root Transfer with Vascularized Nerve Grafting to Treat Brachial Plexus Root Avulsion

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90051-5 ◽

1994 ◽

Vol 19 (1) ◽

pp. 60-66 ◽

Cited By ~ 27

Author(s):

L. CHEN ◽

Y-D. GU

Keyword(s):

Brachial Plexus ◽

Ulnar Nerve ◽

Phrenic Nerve ◽

Nerve Transfer ◽

Nerve Graft ◽

Functional Evaluation ◽

Nerve Grafting ◽

Root Avulsion ◽

Nerve Grafts ◽

Healthy Side

Experimental rat models of simulated brachial plexus injuries were devised to compare the effect of contralateral C7 root transfer with phrenic neurotization. The effect of vascularized nerve grafting (VNG) was also compared with the use of conventional nerve grafts (CNG) in the treatment of root avulsion of the brachial plexus. 160 rats were randomly divided into four groups of 40 each; contralateral C7 root transfer with a vascularized ulnar nerve graft (C7-VNG), contralateral C7 root transfer with conventional ulnar nerve grafting (C7-CNG), ipsilateral phrenic nerve transfer with a vascularized ulnar nerve graft (P-VNG) and ipsilateral phrenic nerve transfer with conventional ulnar nerve grafting (P-CNG). Electrophysiological and histological examinations and functional evaluation were performed at different post-operative intervals. C7 root transfer was found to be superior to phrenic nerve transfer and VNG superior to CNG. Severance of the C7 nerve root was not found to affect limb function on the healthy side.

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