Same Modality nerve Reconstruction for Accessory nerve Injuries

2008 ◽  
Vol 139 (6) ◽  
pp. 854-856 ◽  
Author(s):  
Christina K. Magill ◽  
Amy M. Moore ◽  
Susan E. Mackinnon
Keyword(s):  
Sural Nerve ◽  
Motor Nerve ◽  
Nerve Transfer ◽  
Functional Results ◽  
Neck Surgery ◽  
Obturator Nerve ◽  
Accessory Nerve ◽  
Nerve Injuries ◽  
Nerve Reconstruction ◽  
Nerve Grafts

The standard repair of a nerve gap under tension is to use a sensory autograft, such as the medial antebrachial cutaneous or the sural nerve. The practice of using sensory grafts to repair motor nerve defects is challenged by the discovery of preferential motor reinnervation and modality specific nerve regeneration. In this article, two clinical cases are presented where accessory nerve injuries are repaired with either a motor nerve transfer (a branch of C7) or a motor autograft (obturator nerve), and excellent functional results are reported. These cases provide a stimulus to consider the use of motor nerve grafts or transfers in the repair of motor nerve deficits. © 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

Future Perspectives in the Management of Nerve Injuries

2018 ◽  
Vol 34 (09) ◽  
pp. 672-674 ◽  
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.

scholarly journals Correction of iatrogenic injury of the obturator nerve during pelvic laparoscopic lymphadenectomy by the use of sural nerve grafts

2014 ◽  
Vol 10 ◽  
pp. 16-18 ◽  
Author(s):  
A.R. Dias ◽  
A. Silva e Silva ◽  
J.P. Carvalho ◽  
E.C. Baracat ◽  
G. Favero
Keyword(s):  
Sural Nerve ◽  
Obturator Nerve ◽  
Iatrogenic Injury ◽  
Nerve Grafts

Contralateral spinal accessory nerve for ipsilateral neurotization of branches of the brachial plexus: a cadaveric feasibility study

2011 ◽  
Vol 114 (6) ◽  
pp. 1538-1540 ◽  
Author(s):  
R. Shane Tubbs ◽  
Martin M. Mortazavi ◽  
Mohammadali M. Shoja ◽  
Marios Loukas ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Brachial Plexus ◽  
Spinous Process ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Average Diameter ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Injuries ◽  
Potential Donor ◽  
Spinal Accessory

Object Additional nerve transfer options are important to the peripheral nerve surgeon to maximize patient outcomes following nerve injuries. Potential regional donors may also be injured or involved in the primary disease. Therefore, potential contralateral donor nerves would be desirable. To the authors' knowledge, use of the contralateral spinal accessory nerve (SAN) has not been explored for ipsilateral neurotization procedures. In the current study, therefore, the authors aimed to evaluate the SAN as a potential donor nerve for contralateral nerve injuries by using a novel technique. Methods In 10 cadavers, the SAN was harvested using a posterior approach, and tunneled subcutaneously to the contralateral side for neurotization to various branches of the brachial plexus. Measurements were made of the SAN available for transfer and of its diameter. Results The authors found an SAN length of approximately 20 cm (from transition of upper and middle fibers of the trapezius muscle to approximately 2–4 cm superior to the insertion of the trapezius muscle onto the spinous process of T-12) available for nerve transposition. The average diameter was 2.5 mm. Conclusions Based on these findings, the contralateral SAN may be considered for ipsilateral neurotization to the suprascapular and axillary nerves.

Transfer of the Platysma Motor Branch to the Accessory Nerve in a Patient With Trapezius Muscle Palsy and Total Avulsion of the Brachial Plexus

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. E567-E570 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Motor Nerve ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Motor Branch ◽  
Upper Trapezius

Abstract BACKGROUND AND IMPORTANCE: To report on the successful use of a platysma motor nerve transfer to the accessory nerve in a patient with concomitant trapezius and brachial plexus palsy. CLINICAL PRESENTATION: A 20-year-old man presented with total avulsion of the right brachial plexus combined with palsies of the accessory and phrenic nerve. The patient was operated on 4 months after his injury. The accessory nerve was repaired via direct transfer of the platysma motor branch. The contralateral C7 root was connected to the musculocutaneous nerve, and the hemihypoglossal nerve was grafted to the suprascapular nerve. Two intercostal nerves were attached to the triceps long head motor branch. CONCLUSION: Within 20 months of surgery, the patient regained full reinnervation of the upper trapezius muscle. Elbow flexion scored M3+, and 30° active shoulder abduction was observed. Triceps reinnervation was poor. Platysma motor branch transfer to the accessory nerve is a viable alternative to reinnervate the trapezius muscle.

Use of Vascularized Sural Nerve Grafts for Sciatic Nerve Reconstruction After Malignant Bone and Soft Tissue Tumor Resection in the Lower Legs

2018 ◽  
Vol 80 (4) ◽  
pp. 379-383 ◽  
Author(s):  
Hideki Tokumoto ◽  
Shinsuke Akita ◽  
Yoshitaka Kubota ◽  
Motone Kuriyama ◽  
Nobuyuki Mitsukawa
Keyword(s):  
Soft Tissue ◽  
Sciatic Nerve ◽  
Sural Nerve ◽  
Soft Tissue Tumor ◽  
Tumor Resection ◽  
Nerve Reconstruction ◽  
Nerve Grafts ◽  
Tissue Tumor

Surgical Outcomes of 111 Spinal Accessory Nerve Injuries

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1106-1113 ◽  
Author(s):  
Daniel H. Kim ◽  
Yong-Jun Cho ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Surgical Outcomes ◽  
Neck Surgery ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
State University ◽  
Nerve Injuries ◽  
Spinal Accessory ◽  
Louisiana State University ◽  
Operative Exploration ◽  
Grade 3

Abstract OBJECTIVE Iatrogenic injury to the spinal accessory nerve is not uncommon during neck surgery involving the posterior cervical triangle, because its superficial course here makes it susceptible. We review injury mechanisms, operative techniques, and surgical outcomes of 111 surgical repairs of the spinal accessory nerve. METHODS This retrospective study examines clinical and surgical experience with spinal accessory nerve injuries at the Louisiana State University Health Sciences Center during a period of 23 years (1978–2000). Surgery was performed on the basis of anatomic and electrophysiological findings at the time of operation. Patients were followed up for an average of 25.6 months. RESULTS The most frequent injury mechanism was iatrogenic (103 patients, 93%), and 82 (80%) of these injuries involved lymph node biopsies. Eight injuries were caused by stretch (five patients) and laceration (three patients). The most common procedures were graft repairs in 58 patients. End-to-end repair was used in 26 patients and neurolysis in 19 patients if the nerve was found in continuity with intraoperative electrical evidence of regeneration. Five neurotizations, two burials into muscle, and one removal of ligature material were also performed. More than 95% of patients treated by neurolysis supported by positive nerve action potential recordings improved to Grade 4 or higher. Of 84 patients with lesions repaired by graft or suture, 65 patients (77%) recovered to Grade 3 or higher. The average graft length was 1.5 inches. CONCLUSION Surgical exploration and repair of spinal accessory nerve injuries is difficult. With perseverance, however, these patients with complete or severe deficits achieved favorable functional outcomes through operative exploration and repair.

Results after delayed axillary nerve reconstruction with interposition of sural nerve grafts

2010 ◽  
Vol 19 (3) ◽  
pp. 461-466 ◽  
Author(s):  
Beat K. Moor ◽  
Mathias Haefeli ◽  
Samy Bouaicha ◽  
Ladislav Nagy
Keyword(s):  
Sural Nerve ◽  
Axillary Nerve ◽  
Nerve Reconstruction ◽  
Nerve Grafts

Microneurovascular Reconstruction for Facial Reanimation

2019 ◽  
pp. 393-402
Author(s):  
Michael Klebuc
Keyword(s):  
Sural Nerve ◽  
Motor Nerve ◽  
Muscle Flap ◽  
Nerve Graft ◽  
Muscle Flaps ◽  
Nerve Grafts ◽  
Free Muscle Flap ◽  
Graft Harvest ◽  
Facial Reanimation ◽  
Sural Nerve Graft

Microneurovascular muscle flaps can be effectively employed to reanimate the paralyzed mid-face. This chapter explores the indications and contraindications for free muscle flap smile restoration. Various sources of innervation are examined including the motor nerve to masseter and cross-face nerve grafts, as are different muscle flap donor sites. A detailed description of facial nerve exploration, sural nerve graft harvest, and the cross-face nerve graft procedure are provided. Single and two-staged facial reanimation procedures utilizing free gracilis muscle flaps are also described in detail, including technical nuances, postoperative care, and physical therapy. The technique is well suited for individuals whose native muscles of facial expression have failed to develop in utero, undergone irreversible atrophy, sustained significant trauma, or have been sacrificed during oncologic resection.

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