Intercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions

2013 ◽  
Vol 39 (6) ◽  
pp. 647-652 ◽  
Author(s):  
W. Pondaag ◽  
M. J. A. Malessy
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Consecutive Series ◽  
Biceps Muscle ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Obstetric Brachial Plexus ◽  
Transfer Group

In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. The present study reports the results of both techniques from a single institution in a consecutive series of 42 patients between 1995 and 2008. From 1995 to 2000 we always used the intercostal nerve transfer, and from 2001 to 2008 both techniques were used. Biceps muscle force ≥Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group ( n = 25) and the intercostal nerve transfer group ( n = 17).

Elbow flexion strength and contractile activity after partial ulnar nerve or intercostal nerve transfers for brachial plexus injuries

2020 ◽  
Vol 45 (8) ◽  
pp. 818-826
Author(s):  
Dawn Sinn Yii Chia ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Muscle Power ◽  
Contractile Activity ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Intercostal Nerve ◽  
Nerve Transfers ◽  
Forearm Muscles ◽  
Flexion Strength

We compared the outcomes of 23 partial ulnar nerve and 15 intercostal nerve transfers for elbow flexion reconstruction in patients with C56 or C567 brachial plexus injuries using manual muscle power, dynamometric measurements of elbow flexion strength and electromyography. The range of elbow flexion and muscle strength recovery to Grade 3 or 4 were comparable between the two groups. The patients with C567 injuries had significantly stronger eccentric contraction after the partial ulnar nerve transfer than after the intercostal nerve transfer ( p < 0.05). Electromyography of individual muscles demonstrated that the patients with partial ulnar nerve transfers were unable to voluntarily isolate biceps contraction and recruited forearm flexors and extensors. The patients after partial ulnar nerve transfer had significantly more activity of the forearm muscles during concentric elbow flexion than after intercostal nerve transfers ( p < 0.05). We conclude that partial ulnar nerve transfers were superior to intercostal nerve transfers when assessed quantitatively with the dynamometer to evaluate elbow flexion, although simultaneous recruitment of forearm muscles may have contributed to the increased elbow flexion strength in the patients with the partial ulnar nerve transfer. Level of evidence: III

Pulmonary and Biceps Function after Intercostal and Phrenic Nerve Transfer for Brachial Plexus Injuries

2004 ◽  
Vol 29 (1) ◽  
pp. 8-11 ◽  
Author(s):  
P. CHALIDAPONG ◽  
K. SANANPANICH ◽  
J. KRAISARIN ◽  
C. BUMROONGKIT
Keyword(s):  
Pulmonary Function ◽  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Vital Capacity ◽  
Randomized Study ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Forced Expiratory Volume ◽  
Motor Recovery ◽  
Transfer Group

This pseudo-randomized study was performed to compare the pulmonary function and biceps recovery after intercostal (19 cases) and phrenic (17 cases) nerve transfer to the musculocutaneous nerve for brachial plexus injury patients with nerve root avulsions. Pulmonary function was assessed pre-operatively and postoperatively by measuring the forced vital capacity, forced expiratory volume in 1 second, vital capacity, and tidal volume. Motor recovery of biceps was serially recorded. Our results revealed that pulmonary function in the phrenic nerve transfer group was still significantly reduced 1 year after surgery. In the intercostal nerve transfer group, pulmonary function was normal after 3 months. Motor recovery of biceps in the intercostal nerve group was significantly earlier than that in phrenic nerve group. We conclude that pulmonary and biceps functions are better after intercostal nerve transfer than after phrenic nerve transfer in the short term at least.

Intercostal nerve transfer in infants with obstetric brachial plexus palsy

Microsurgery ◽  
2008 ◽  
Vol 28 (7) ◽  
pp. 499-504 ◽  
Author(s):  
Tarek A. El-Gammal ◽  
Mohamed M. Abdel-Latif ◽  
Mohamed M. Kotb ◽  
Amr El-Sayed ◽  
Yasser Farouk Ragheb ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus

scholarly journals Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

2021 ◽  
Author(s):  
Teodor Stamate ◽  
Dan Cristian Moraru
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Distal Stump ◽  
Brachial Plexus Palsy ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Intercostal Nerves ◽  
Thoracodorsal Nerve

Nerve transfers (NT) consist in sectioning a donor nerve and connecting it to the distal stump of a recipient unrepairable nerve. For elbow flexion restoration in brachial plexus palsy (BPP) we used different NT: 1) GF motor Ulnar Nerve to Biceps nerve (Oberlin technique), 2) Double fascicular median/ulnar to biceps/brachialis nerve transfer (Mackinnon), 3) InterCostal Nerves (ICN) to MCN (+/− nerve graft), 4) Medial Pectoral Nerve (MPN) to MCN, 5) ThoracoDorsal Nerve (TDN) to MCN, 6) Spinal Accessory Nerve (SAN) to MCN transfer, 7) Phrenic Nerve (PhN) to MCN, 8) Cervical Plexus C3-C4 to MCN and 9) Contralateral C7 (CC7). I want to present my personal experience using the phrenic nerve (PhN), the intercostal nerves (ICN) and Oberlin’s technique. The aim of this retrospective study is to evaluate the results of this procedure in BPP. NT is an important goal in BPP. ICN transfer into the nerve of biceps for elbow flexion recovery is a reliable procedure in BPP. ICN transfer for triceps offers a positive alternative (Carroll transposition). Oberlin technique is simple and offers better results in a shorter amount of time and is an effective and safe option.

scholarly journals Collateral branches of the brachial plexus as donors in nerve transfers

2012 ◽  
Vol 69 (7) ◽  
pp. 594-603 ◽  
Author(s):  
Miroslav Samardzic ◽  
Lukas Rasulic ◽  
Novak Lakicevic ◽  
Vladimir Bascarevic ◽  
Irena Cvrkota ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Statistical Significance ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Quality Of Recovery ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Thoracodorsal Nerve

Background/Aim. Nerve transfers in cases of directly irreparable, or high level extensive brachial plexus traction injuries are performed using a variety of donor nerves with various success but an ideal method has not been established. The purpose of this study was to analyze the results of nerve transfers in patients with traction injuries to the brachial plexus using the thoracodorsal and medial pectoral nerves as donors. Methods. This study included 40 patients with 25 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. The results were analyzed according to the donor nerve, the age of the patient and the timing of surgery. Results. The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100%, 93.7% and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5%, 83.3% and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. Conclusion. According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery.

RESTORATION OF ELBOW FLEXOR IN BRACHIAL PLEXUS INJURED PATIENTS

Hand Surgery ◽  
1998 ◽  
Vol 03 (02) ◽  
pp. 205-214 ◽  
Author(s):  
Preecha Chalidapong ◽  
Kanit Sananpanich ◽  
Korku Chiengthong ◽  
Variya Sakares
Keyword(s):  
Brachial Plexus ◽  
Biceps Brachii ◽  
Rectus Femoris ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Weight Lifting ◽  
Elbow Flexor ◽  
Nerve Transfers ◽  
Dorsi Muscle ◽  
Injured Patients

Biceps brachii is one major elbow flexor, which is innervated by the musculocutaneous nerve from the C5 and C6 root. From 1987 to 1996, the elbow flexor restoration procedures were performed in 461 brachial plexus injured patients by means of 347 intercostal nerve transfers, with 105° arc of flexion and 2.05 kg weight lifting; intercostal nerve transfer to 34 gracilles and 7 rectus femoris free vascularized muscle transplantation, with 111.45 and 86° arc of flexion, and 2.77 and 1.9 kg weight lifting, respectively; 41 modified Steindler flexorplasty, with 74.9° arc of flexion and 2.01 kg weight lifting; 27 lattisimus dorsi muscle (Zancolli's bipolar method), with 127.7° arc of flexion and 3.15 kg weight lifting; 3 pectoralis major tendon (Goldner's method), with 85° arc of flexion and 1.3 kg weight lifting; and 2 triceps muscle (Carroll's method) with 85° arc of flexion and 1.5 kg weight lifting. A comparison shows that, the latissimus dorsi muscle transfer obtained the best result for arc of flexion and weight lifting, followed by the gracilles muscle and the intercostal nerve transfer procedure, respectively.

A New Technique for Mismatched Nerve Suture in Direct Intercostal Nerve Transfers

1993 ◽  
Vol 18 (3) ◽  
pp. 318-319 ◽  
Author(s):  
N. OCHIAI ◽  
Y. MIKAMI ◽  
S. YAMAMOTO ◽  
T. NAKAGAWA ◽  
A. NAGANO
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
New Technique ◽  
Nerve Suture ◽  
Nerve Transfers ◽  
Suturing Technique ◽  
A New Technique

We introduce a new suturing technique for intercostal nerve transfer in brachial plexus injuries. This method allows the anastomosis of nerves of unequal diameter.

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