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

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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A Comparative Study of Nerve Reconstruction Techniques in Phrenic Nerve Tranfer for Treatment of Brachial Plexus Root Avulsion Injuries

Hand Surgery ◽

10.1142/s0218810497000057 ◽

1997 ◽

Vol 02 (01) ◽

pp. 25-33 ◽

Cited By ~ 1

Author(s):

Yu-Dong Gu ◽

Jian-Jun Ma

Keyword(s):

Brachial Plexus ◽

Phrenic Nerve ◽

Recovery Of Function ◽

Nerve Transfer ◽

Nerve Grafting ◽

Root Avulsion ◽

Sprague Dawley ◽

Nerve Reconstruction ◽

Sprague Dawley Rats ◽

Nerve Implantation

This experimental study investigated the effectiveness of three methods of neurorrhaphy, nerve grafting and nerve implantation in phrenic nerve transfer for treatment of brachial plexus root avulsion injuries. 180 Sprague-Dawley rats were used. The electrophysiological, histological and muscle functional evaluations were performed at 1, 2, 3, 4, 5 and 6-month postoperatively. Variable recovery in each group was found at different postoperative intervals. At six months after operation, the following results were observed in descending order of superiority: neurorrhaphy, nerve grafting, nerve implantation. Nerve implantation demonstrated a recovery of function of 75.76% and the characteristic electrical activity of the phrenic nerve might contribute to the motor endplate regeneration. Our experimental results will serve as the basis for our clinical practice.

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Outcome after transfer of intercostal nerves to the nerve of triceps long head in 25 adult patients with total brachial plexus root avulsion injury

Journal of Neurosurgery ◽

10.3171/2012.10.jns12637 ◽

2013 ◽

Vol 118 (3) ◽

pp. 606-610 ◽

Cited By ~ 19

Author(s):

KaiMing Gao ◽

Jie Lao ◽

Xin Zhao ◽

YuDong Gu

Keyword(s):

Brachial Plexus ◽

Phrenic Nerve ◽

Nerve Transfer ◽

Effective Rate ◽

Root Avulsion ◽

Factors Affecting ◽

Triceps Muscle ◽

Significant Difference ◽

Long Head ◽

Intercostal Nerves

Object The intercostal nerves (ICNs) have been used to repair the triceps branch in some organizations in the world, but the reported results differ significantly. The effect of this procedure requires evaluation. Thus, this study aimed to evaluate the outcome of ICN transfer to the nerve of the long head of the triceps muscle and to determine the factors affecting the outcome of this procedure. Methods A retrospective review was conducted in 25 patients with global root avulsion brachial plexus injuries who underwent ICN transfer. The nerves of the long head of the triceps were the recipient nerves in all patients. The ICNs were used in 2 different ways: 2 ICNs were used as donor nerves in 18 patients, and 3 ICNs were used in 7 patients. The mean follow-up period was 5.6 years. Results The effective rate of motor recovery in the 25 patients was 56% for the function of the long head of the triceps. There was no significant difference in functional recovery between the patients with 2 or 3 ICN transfers. The outcome of this procedure was not altered if combined with phrenic nerve transfer to the biceps branch. Patients in whom surgery was delayed 6 months or less achieved better results. Conclusions The transfer of ICNs to the nerve of long head of the triceps is an effective procedure for treating global brachial plexus avulsion injuries, even if combined with phrenic nerve transfer to the biceps branch. Two ICNs appear to be sufficient for donation. The earlier the surgery is performed, the better are the results achieved.

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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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Digital Nerve Grafting Using the Dorsal Sensory Branch of the Ulnar Nerve

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(85)80012-7 ◽

1985 ◽

Vol 10 (1) ◽

pp. 37-40 ◽

Cited By ~ 21

Author(s):

T. L. GREENE ◽

J. B. STEICHEN

Keyword(s):

Ulnar Nerve ◽

Hand Function ◽

Nerve Graft ◽

The Other ◽

Nerve Grafting ◽

Digital Nerve ◽

Nerve Grafts ◽

Neuroma Formation

The dorsal sensory branch of the ulnar nerve has been found to have the appropriate size and sufficient length for use as a digital nerve graft. This donor nerve was utilised fifteen times in twelve patients for the bridging of defects in thirteen digital nerves of the fingers. After an average follow-up of 23.2 months, only one patient failed to achieve any two point discrimination in the area supplied by the involved digital nerve. The other eleven patients had an average two point discrimination of 9.5 mm with a range of 5 to 18 mm. Painful neuroma formation or loss of hand function related to the use of the dorsal sensory branch of the ulnar nerve as a donor for digital nerve grafts was not encountered.

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Reliability of functioning free muscle transfer and vascularized ulnar nerve grafting for elbow flexion in complete brachial plexus palsy

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417702029 ◽

2017 ◽

Vol 42 (7) ◽

pp. 693-699 ◽

Cited By ~ 7

Author(s):

S. M. Potter ◽

S. I. Ferris

Keyword(s):

Brachial Plexus ◽

Ulnar Nerve ◽

Brachial Plexus Injury ◽

Elbow Flexion ◽

Nerve Graft ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Muscle Transfer ◽

Spinal Accessory ◽

Nerve Grafts

We compared outcomes of primary vascularized ulnar nerve grafts from the C5 root neurotizing biceps and brachialis muscles, and gracilis functioning free muscle transfer neurotized by the distal spinal accessory nerve, as a primary or salvage procedure after complete brachial plexus injury. At 45 months, three of eight primary vascularized ulnar nerve graft patients regained grade 4 elbow flexion, while one regained grade 3. All 13 primary gracilis transfer patients regained grade 4 elbow flexion. Four patients with vascularized ulnar nerve grafts failed and subsequently had salvage functioning free muscle transfer procedures resulting in delayed recovery. Although vascularized ulnar nerve graft-based primary reconstructions can provide useful elbow flexion, this was achieved in less than half the cases. We consider primary gracilis functioning free muscle transfer neurotized by the distal spinal accessory nerve as the most reliable reconstruction for the restoration of elbow flexion in complete brachial plexus injury. Level of evidence: IV

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Seventh Cervical Nerve Root Transfer from the Contralateral Healthy Side for Treatment of Brachial Plexus Root Avulsion

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80235-9 ◽

1992 ◽

Vol 17 (5) ◽

pp. 518-521 ◽

Cited By ~ 170

Author(s):

Y-D. GU ◽

G-M. ZHANG ◽

D-S. CHEN ◽

J-G. YAN ◽

X-M. CHENG ◽

...

Keyword(s):

Brachial Plexus ◽

Nerve Transfer ◽

Contralateral Side ◽

Root Avulsion ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

New Approach ◽

Healthy Side ◽

Cervical Root

Cervical root nerve transfer from the contralateral side has been used for the treatment of brachial plexus root avulsion in 49 patients. Resection of C7 root from the healthy side has produced no long-term symptoms or signs. Nine patients with ten recipient nerves have been followed up for more than two years and seven have obtained a functional recovery. This operation offers a new approach for the treatment of brachial plexus root avulsion.

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Prolonging Nerve Grafts Using Chemical Extracted Muscle-in-vein with Vein Window Method Chemical acellular nerve grafts

Revista de Chimie ◽

10.37358/rc.17.12.6011 ◽

2018 ◽

Vol 68 (12) ◽

pp. 2936-2940

Author(s):

Irina Mihaela Jemnoschi Hreniuc ◽

Camelia Tamas ◽

Sorin Aurelian Pasca ◽

Bogdan Ciuntu ◽

Roxana Ciuntu ◽

...

Keyword(s):

Classical Group ◽

Donor Site ◽

Good Alternative ◽

Nerve Graft ◽

Male Rats ◽

Chemical Extraction ◽

Nerve Grafting ◽

Nerve Grafts ◽

Local Resources ◽

Window Method

Nerve injuries are a common pathology in hand trauma. The consequences are drastic both for patients and doctors/medical system. In many cases direct coaptation is impossible. A nerve graft should be used in the case of a neuroma, trauma or tumor, for restoration of nervous influx. The aim of this study is demonstrate that by grafting restant nerve stumps with muscle-in-vein nerve grafts we obtain good result in terms of functional and sensibility recovery and also our method �window-vein� is a good way of prolonging nerve grafts. The method of study is experimental. We worked in the laboratory in optimal conditions for carrying out of muscles-in-vein nerve grafts (nerve grafts size 1.5 cm-3 cm). We used acellular muscle grafts with the chemical extraction method.The study was conducted on experimental animals (Wistar male rats).We used 30 experience animals in 3 equal groups (classical group and muscle-in-vein nerve grafts-2 nerve grafts of 1,5 cm central sutured and the third group with muscle-in-vein nerve grafts, window-vein method, 3 cm). At 4 and respectively 6 weeks postoperative at the quality tests we observed the progress with the footprint test. The operated hind in comparison with the healthy hind was 86% recovered and similar with classic nerve grafts. Quantitatively the number of regenerated axons in the group with muscle-in-vein nerve grafts was significant bigger in comparison with the classical group (15%).The method using muscle-in-vein nerve graft with windows-vein it�s a good alternative for nerve grafting in comparison with classical nerve grafting. When the local possibilities are limited, this method is good for prolonging the grafts. The relationship between cost and benefit in this case it�s an advantage because we use the local resources of the affected area. The motor results of nerve grafting ingroup 2 in comparison with group 3 were similar and in some cases better in group 1. Grafting with MVNG offers a better alternative for donor site regeneration in comparison with classical nerve grafts. This method is useful to prolong nerve grafts without adding morbidity.

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Transfer of a Motor Fascicle From the Ulnar Nerve to the Branch of the Radial Nerve Destined to the Long Head of the Triceps for Restoration of Elbow Extension in Brachial Plexus Surgery

Neurosurgery ◽

10.1227/neu.0b013e31822ac120 ◽

2011 ◽

Vol 70 (2) ◽

pp. E516-E520 ◽

Cited By ~ 11

Author(s):

Leandro Pretto Flores

Keyword(s):

Computed Tomography ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Radial Nerve ◽

Nerve Transfer ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Elbow Extension ◽

Long Head ◽

Brachial Plexus Surgery

Abstract BACKGROUND AND IMPORTANCE: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. CLINICAL PRESENTATION: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases. CONCLUSION: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.

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Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction

Journal of Neurosurgery ◽

10.3171/jns.2004.101.5.0770 ◽

2004 ◽

Vol 101 (5) ◽

pp. 770-778 ◽

Cited By ~ 38

Author(s):

Jayme Augusto Bertelli ◽

Marcos Flávio Ghizoni

Keyword(s):

Brachial Plexus ◽

Ulnar Nerve ◽

Phrenic Nerve ◽

Cranial Nerve ◽

External Rotation ◽

Elbow Flexion ◽

Content Type ◽

Nerve Transfers ◽

Contralateral Motor ◽

Fine Print

Object. The goal of this study was to evaluate outcomes in patients with brachial plexus avulsion injuries who underwent contralateral motor rootlet and ipsilateral nerve transfers to reconstruct shoulder abduction/external rotation and elbow flexion. Methods. Within 6 months after the injury, 24 patients with a mean age of 21 years underwent surgery in which the contralateral C-7 motor rootlet was transferred to the suprascapular nerve by using sural nerve grafts. The biceps motor branch or the musculocutaneous nerve was repaired either by an ulnar nerve fascicular transfer or by transfer of the 11th cranial nerve or the phrenic nerve. The mean recovery in abduction was 90° and 92° in external rotation. In cases of total palsy, only two patients recovered external rotation and in those cases mean external rotation was 70°. Elbow flexion was achieved in all cases. In cases of ulnar nerve transfer, the muscle scores were M5 in one patient, M4 in six patients, and M3+ in five patients. Elbow flexion repair involving the use of the 11th cranial nerve resulted in a score of M3+ in five patients and M4 in two patients. After surgery involving the phrenic nerve, two patients received a score of M3+ and two a score of M4. Results were clearly better in patients with partial lesions and in those who were shorter than 170 cm (p < 0.01). The length of the graft used in motor rootlet transfers affected only the recovery of external rotation. There was no permanent injury at the donor sites. Conclusions. Motor rootlet transfer represents a reliable and potent neurotizer that allows the reconstruction of abduction and external rotation in partial injuries.

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