Outcomes of Nerve Transfer versus Nerve Graft in Ulnar Nerve Laceration

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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“In Situ Vascular Nerve Graft” for Restoration of Intrinsic Hand Function: An Anatomical Study

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500297 ◽

2018 ◽

Vol 23 (02) ◽

pp. 248-254

Author(s):

Kamran Mozaffarian ◽

Hamid Reza Zemoodeh ◽

Mohammad Zarenezhad ◽

Mohammad Owji

Keyword(s):

Ulnar Nerve ◽

Hand Function ◽

Anatomical Study ◽

Nerve Transfer ◽

Nerve Graft ◽

Posterior Interosseous Nerve ◽

Motor Branch ◽

Ulnar Nerve Injury ◽

High Median

Background: In combined high median and ulnar nerve injury, transfer of the posterior interosseous nerve branches to the motor branch of the ulnar nerve (MUN) is previously described in order to restore intrinsic hand function. In this operation a segment of sural nerve graft is required to close the gap between the donor and recipient nerves. However the thenar muscles are not innervated by this nerve transfer. The aim of the present study was to evaluate whether the superficial radial nerve (SRN) can be used as an “in situ vascular nerve graft” to connect the donor nerves to the MUN and the motor branch of median nerve (MMN) at the same time in order to address all denervated intrinsic and thenar muscles. Methods: Twenty fresh male cadavers were dissected in order to evaluate the feasibility of this modification of technique. The size of nerve branches, the number of axons and the tension at repair site were evaluated. Results: This nerve transfer was technically feasible in all specimens. There was no significant size mismatch between the donor and recipient nerves Conclusions: The possible advantages of this modification include innervation of both median and ulnar nerve innervated intrinsic muscles, preservation of vascularity of the nerve graft which might accelerate the nerve regeneration, avoidance of leg incision and therefore the possibility of performing surgery under regional instead of general anesthesia. Briefly, this novel technique is a viable option which can be used instead of conventional nerve graft in some brachial plexus or combined high median and ulnar nerve injuries when restoration of intrinsic hand function by transfer of posterior interosseous nerve branches is attempted.

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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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