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At least 55 records · Page 3Linked to original sources
PubMed2006

Combined nerve transfers for C5 and C6 brachial plexus avulsion injury.

PURPOSE: To report the results of combined nerve transfer in C5 and C6 brachial plexus avulsion injury. METHODS: Fifteen patients had nerve transfers: spinal accessory nerve to the suprascapular nerve, a part of the ulnar nerve to the biceps motor branch, and the nerve to the long head of the triceps to the anterior branch of the axillary nerve. Patients were evaluated with regard to elbow flexion, shoulder abduction, and shoulder external rotation. RESULTS: All patients had recovered full elbow flexion: 13 scored M4 and 2 scored M3. Thirteen of the 15 patients obtained good results. The weight the patients could lift ranged from 0 to 7 kg. All patients had recovery of the deltoid function: 13 scored M4 and 2 scored M3. All 15 patients achieved useful functional recovery. Ten patients experienced excellent recoveries and 5 were classified as having good results. The mean shoulder abduction was 115 degrees . Shoulder external rotation strength was scored as M4 in 9 patients, M3 in 4 patients, and M2 in 2 patients. The range of motion of external rotation that was measured from full internal rotation averaged 97 degrees . No clinical donor nerve deficits were observed. CONCLUSIONS: We recommend combined nerve transfers for C5 and C6 avulsion root injuries. These nerve transfers have the advantage of a quick recovery time as a result of the short regeneration distance without nerve graft. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Accessory Nerve↗
PubMed1994

Intercostal nerve transfer for brachial plexopathy.

Thirteen patients with traumatic brachial plexopathy underwent intercostal nerve transfer to the biceps motor branch (9 patients) or combined gracilis muscle and intercostal nerve transfer (4 patients; 3 for elbow flexion and 1 for elbow extension). Follow-up time ranged from 12 to 48 months (mean, 25 months) on 12 patients. Useful elbow flexion or extension was obtained in a total of 9 patients. Comparison of pre- and postoperative spirometry in 4 patients demonstrated a mild decline in pulmonary function, although there was no subjective change in respiratory status. Intercostal nerve transfer and combined gracilis muscle and intercostal nerve transfer are viable, although technically demanding, alternatives for restoring active elbow motion in patients with irreparable brachial plexus lesions when conventional tendon transfers are not feasible. The morbidity of intercostal nerve harvest with respect to pulmonary function is minimal.

Adult↗
PubMed1983

Intercostal nerve transfer in brachial plexus injuries: an experimental study.

Eighteen adult mongrel dogs underwent unilateral surgical disruption of the brachial plexus. Twelve animals (Group I) had as a second-stage procedure transfer of T4 and T5 intercostal nerves and their accompanying vascular bundles to the distal musculocutaneous nerve stump. Six animals (Group II) had restoration of musculocutaneous nerve continuity with conventional interpositional sural nerve cable grafts. Group I animals demonstrated significantly better electromyographic evidence of reinnervation and, comparing appearance and weight of operated and unoperated biceps muscles at the time of animal sacrifice, maintained greater gross weight and more normal overall appearance of muscle. Histologic study of muscle tissue showed no significant difference between the two groups whereas musculocutaneous nerve histology distal to all anastomoses revealed less fibrous tissue and a greater number of healthy-appearing axons in Group I. It is concluded that vascularized intercostal nerve transfer as performed in this study has theoretical advantages over conventional nonvascularized intercostal nerve transfer but additional investigation is required to make this determination. The superiority of vascularized intercostal nerve transfers over conventional interpositional sural nerve cable grafts has been demonstrated.

Animals↗
PubMed2004

Sensory nerves transfers.

Various types of sensory nerve transfer in the hand are presented. They were all performed after brachial plexus injury to restore sensation, mainly to the adjacent borders of the thumb and index finger or to the ulnar aspect of the little finger. Twenty one cases were assessed. Their outcomes according to the Highet-Zachary system were: S2 in nine cases, S2 in four cases, S1 in four cases and S0 in four cases.

Brachial Plexus↗
PubMed1999

Can vascularization improve the surgical outcome of the intercostal nerve transfer for traumatic brachial plexus palsy? A clinical comparison of vascularized and non-vascularized methods.

It is very difficult to design a well-controlled comparative study for clarifying the value of vascularized nerve grafting in clinical cases. In order to understand whether or not the vascularizing procedure has any clinical value in nerve transfer and in nerve grafting, we compared non-vascularized with vascularized intercostal nerve transfer in patients with brachial plexus injury. Factors that were likely to affect the results were controlled. We found there was no significant difference in the functional outcome and no difference in the regenerating rate of the nerves between nonvascularized and vascularized intercostal nerve transfer. We concluded that the vascularizing procedure had little clinical value not only in intercostal nerve transfer, but also in nerve grafting irrespective of the length of the gap, when the recipient bed had normal vascularity.

Adolescent↗
PubMed2000

Nerve transfers in the upper extremity.

Restoration of extremity function following nerve injury is often unpredictable. Nerve transfers in the upper extremity are important techniques in the management of many types of peripheral nerve injury. The physiologic principles of nerve transfer lead to the indications for use. The elements of planning and execution of common nerve transfers are presented in this article.

Arm↗
PubMed1991

A functional evaluation of ansa cervicalis nerve transfer for unilateral vocal cord paralysis: future directions for laryngeal reinnervation.

There are a variety of methods for treating unilateral vocal cord paralysis, but to date there are few objective studies that evaluate the functional results of nerve transfer from the ansa cervicalis. Six dogs underwent unilateral recurrent laryngeal nerve section with immediate reanastamosis to the sternothyroid branch of the ansa cervicalis. After 5 to 6 months, measurements of vocal efficiency and acoustic parameters, videolaryngoscopy, videostroboscopy, and evoked electromyography were performed. Identical measurements were made in eight control dogs during normal electrically induced phonation and a simulated unilateral recurrent laryngeal nerve paralysis. Histologic analysis of both vocalis muscles, recurrent laryngeal nerves, ansa cervicalis, and the ansa-recurrent laryngeal nerve anastamosis site was performed. Evidence of reinnervation was found in all of the animals that underwent nerve transfer. The vocal efficiency and acoustic quality after ansa cervicalis nerve transfer were dependent on the degree of electrical stimulation from the transferred nerve to the reinnervated cord during phonation. In the absence of electrical stimulation to the nerve transfer, physiologic vocal cord motion could not be elicited from the reinnervated cord.

Anastomosis, Surgical↗
PubMed2002

Neurophysiologic and clinical outcome following medial pectoral to long thoracic nerve transfer for scapular winging: a case report.

The use of nerve transfers (neurotization) in the reconstruction of nerve palsy is not new, but its clinical efficacy is still largely based on reports of successful restoration of elbow flexion and shoulder abduction following brachial plexus avulsion. Although its potential application extends beyond the brachial plexus, little has been written about additional indications or associated postoperative outcomes. The case described in this report illustrates yet another indication for which neurotization may be a useful technique. Medial pectoral nerve transfer to the long thoracic nerve was performed via an 11-cm sural nerve graft to treat scapular winging 4 months following nerve injury caused during axillary node dissection. Neurophysiologic and clinical outcome 18 months postoperatively revealed successful reinnervation of the serratus anterior muscle, decreased scapular winging, and symptomatic improvement from the patient's perspective.

Axilla↗
PubMed1998

Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases.

Thirty-two patients with absent elbow flexion secondary to brachial plexus injury underwent nerve transfer using 1 or 2 fascicles of the ulnar nerve to the motor branch of the biceps muscle. Twenty-six patients had root avulsion injury of C5 and C6; 4 had root avulsion injury of C5, C6, and C7; and 2 had lateral and posterior cord injury with distal injury of the musculocutaneous nerve. The follow-up period ranged from 11 to 40 months (average, 18 months). Thirty patients had biceps strength of M4 (flexion power ranged from 0.5 to 7 kg) and 1 had biceps strength of M3. All but 1 patient demonstrated signs of recovery of the biceps muscle. No notable impairment of hand function was observed.

Adult↗
PubMed1997

[Treatment of nerve root avulsion of brachial plexus by nerve transfer].

The results of nerve transposition for root avulsion of brachial plexas in 21 cases were reported. The methods of the nerve transposition were divided into four groups as followings: By transfer of phrenic nerve, accesory nerve, the motor branches of cervical plexus and intercostal nerves in cease; By transfer of phrenic nerve, accessory nerve and the motor branches of cervical plexus in 6 cases; By transfer of phrenic nerve and accessory nerve in 9 cases, and by transfer of phrenic nerve or the motor branches of cervical plexus or intercostal nerve in 5 cases. During operation, in 1 cases variation of the brachial plexus was found. Injury to the subclavian artery occurred in 4 cases and they were repaired, which is good for the blood circulation of the upper arm and nerve regeneration. Nineteen cases were followed up with good results. The overall excellent and good rate was 73.7%. It was considered that transposition of nerve should be a routine operation for the treatment of root avulsion of brachial plexus and the accompanied arterial injury should be repaired at the same time during operation, and the latter would be advantageous to enhance functional recovery of nerve.

Accessory Nerve↗
PubMed2001

Intercostal nerve transfer classification.

We report a new classification of intercostal nerve transfer. The specific application in brachial plexus reconstruction is described. This method was applied in intercostal nerve transfer to the musculocutaneous nerve in 15 patients. In type 1, "MOTOR to MIXED" transfer one harvest only the intercostal main motor branch which is connected at the trunk of the musculocutaneous nerve, without fascicular specificity. In type 2, "MIXED to MIXED" transfer, based on neural cartography, the main motor branch and its sensitive accessory anterior branches are connected to the musculocutaneous nerve trunk, in attempt to connect the motor fascicules together at the center and also the sensory fascicules together, at the circumference. In type 3, "MOTOR to MOTOR" transfer, the intercostal main motor branch is connected to the musculocutaneous motor branch directly destined to the biceps brachialis. The aim of this work is to evaluate the results between different series.

Brachial Plexus↗
PubMed2001

Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature.

We report the results of 15 patients who underwent nerve transfer for restoration of shoulder and elbow function at our institution for traumatic brachial plexus palsy. We present these results in the context of a meta-analysis of the English literature, designed to quantitatively assess the efficacy of individual nerve transfers for restoration of elbow and shoulder function in a large number of patients. One thousand eighty-eight nerve transfers from 27 studies met the inclusion criteria of the analysis. Seventy-two percent of direct intercostal to musculocutaneous transfers (without interposition nerve grafts) achieved biceps strength > or =M3 versus 47% using interposition grafts. Direct intercostal transfers to the musculocutaneous nerve had a better ability to achieve > or =M4 elbow strength than transfers from the spinal accessory nerve (41% vs 29%). The suprascapular nerve fared significantly better than the axillary nerve in obtaining > or =M3 shoulder abduction (92% vs 69%). At our institution 90% of intercostal to musculocutaneous transfers (n = 10) achieved > or =M3 bicep strength and 70% achieved > or =M4 strength. Four of seven patients achieved > or =M3 shoulder abduction with a single nerve transfer and 6 of 7 regained > or =M3 strength with a dual nerve transfer. This study suggests that interposition nerve grafts should be avoided when possible when performing nerve transfers. Better results for restoration of elbow flexion have been attained with intercostal to musculocutaneous transfers than with spinal accessory nerve transfers and spinal accessory to suprascapular transfers appear to have the best outcomes for return of shoulder abduction. We conclude that nerve transfer is an effective means to restore elbow and shoulder function in brachial plexus paralysis.

Adolescent↗
PubMedDate not supplied

[Nerve transfer in traction injuries of the brachial plexus].

BACKGROUND: The aim of this study was to analyze the results of nerve transfer to the musculocutaneous and axillary nerves, using some technical modalities such as intercostal, spinal accessory or intraplexal transfer, and on the basis of the results to try to clarify the most common controversies concerning these operations. METHODS: The study included 82 patients with brachial plexus traction injuries, who were operated on using various techniques of nerve transfer. The follow-up period was at least two years. The analysis of biceps and deltoid muscles recovery was performed according to the type of the donor nerve. RESULTS: The corresponding rates of recovery for the musculocutaneous and axillary nerves were 46.7% and 68.1% in intercostal nerve transfer, 71.4% and 75% in accessory nerve transfer, 93.1% and 88.8% in nerve transfer of the brachial plexus collateral branches, and 55.5% and 60% in classical intraplexal nerve transfer, respectively. Comparative statistical analysis demonstrated significantly better final outcome and quality of recovery in regional nerve transfers in comparison to the other methods. CONCLUSION: Our findings suggest that nerve transfer of collateral branches, where possible, (such as in cases with upper or extended upper brachial plexus palsy) might be a method of choice, offering better results and quality of recovery.

Adolescent↗
PubMed2002

Anterior interosseous nerve transfer to the motor branch of the ulnar nerve for high ulnar nerve injuries.

Primary repair of a high ulnar nerve injury results in a uniformly poor outcome as a result of the great distance between the site of injury and the innervated muscles. In this study the authors present two cases of high ulnar nerve injuries in adults. Reconstruction was performed using the distal branch of the anterior interosseous nerve, which was transferred to the distal motor branch of the ulnar nerve. This resulted in timely return of function to the ulnar-innervated intrinsic muscles of the hand, which was documented further by electromyography. For high ulnar nerve injuries, this type of nerve transfer is a much better approach than the traditional primary neurorrhaphy.

Adult↗
PubMed2000

Restoration of shoulder abduction in brachial plexus injury with phrenic nerve transfer.

BACKGROUND: Shoulder abduction is one of the most essential functions in reconstruction of the brachial plexus following injury. In the literature there are few reports on phrenic nerve transfer, especially in relation to restoration of shoulder function. The purpose of the present study was to evaluate the clinical effectiveness and safety of phrenic nerve transfer. METHODS: A study was made of 10 cases of phrenic nerve transfer to the suprascapular nerve. RESULTS: The average shoulder abduction was 41 degrees (range: 20-60 degrees). The average degree of shoulder abduction in patients with C5 or C6 root avulsions was slightly more than that in the patients with total root avulsions. There was no clinically significant respiratory insufficiency in any patient. CONCLUSIONS: Phrenic nerve transfer to the suprascapular nerve is an effective, reliable and safe method of shoulder abduction restoration in brachial plexus injury.

Adult↗
PubMed2004

Treatment of a proximal accessory nerve injury with nerve transfer.

OBJECTIVE AND HYPOTHESIS: This study presents a case report of a patient who sustained an iatrogenic proximal accessory nerve injury that was treated with a medial pectoral to accessory nerve transfer. STUDY DESIGN: Case study. MATERIALS AND METHODS: Chart of one patient who was treated with a medial pectoral to accessory nerve transfer was reviewed. RESULTS: Five months after excision of a branchial cyst that resulted in a very proximal injury to the accessory nerve, this patient underwent a medial pectoral to accessory nerve transfer. At final follow-up, 3 years after surgery, the patient had full abduction overhead with some residual shoulder/scapular discomfort and mild scapular winging. CONCLUSION: The medial pectoral to accessory nerve transfer provides a viable surgical option with good reinnervation of the trapezius muscle in patients with a proximal accessory nerve injury where standard nerve repair or graft techniques are not feasible.

Accessory Nerve↗
PubMed2000

The intercostal to phrenic nerve transfer: an effective means of reanimating the diaphragm in patients with high cervical spine injury.

Nerve transfers have been well described for the treatment of congenital and traumatic injuries in the brachial plexus and extremities. This series is the first to describe nerve transfers to reanimate the diaphragm in patients confined to long-term positive pressure ventilation because of high cervical spine injury. Patients who have sustained injury to the spinal cord at the C3 to C5 level suffer axonal loss in the phrenic nerve. They can neither propagate a nerve stimulus nor respond to implanted diaphragmatic pacing devices (electrophrenic respiration). Ten nerve transfers were performed in six patients who met these conditions. The procedures used end-to-end anastomoses from the fourth intercostal to the phrenic nerve approximately 5 cm above the diaphragm. A phrenic nerve pacemaker was implanted as part of the procedure and was placed distal to the anastomosis. Each week, the pacemaker was activated to test for diaphragmatic response. Once diaphragm movement was documented, diaphragmatic pacing was instituted. Eight of the 10 transfers have had more than 3 months to allow for axonal regeneration. Of these, all eight achieved successful diaphragmatic pacing (100 percent). The average interval from surgery to diaphragm response to electrical stimulation was 9 months. All patients were able to tolerate diaphragmatic pacing as an alternative to positive pressure ventilation, as judged by end tidal CO2 values, tidal volumes, and patient comfort. Intercostal to phrenic nerve transfer with diaphragmatic pacing is a viable means of liberating patients with high cervical spine injury from long-term mechanical ventilation.

Adult↗