Jayme Bertelli

Jayme Bertelli
Governador Celso Ramos Hospital

MD, PhD
Brachial plexus and peripheral nerve surgery Creator of nerve transfer in tetraplegia reconstruction

About

182
Publications
38,194
Reads
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4,796
Citations
Citations since 2017
34 Research Items
1994 Citations
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20172018201920202021202220230100200300400
20172018201920202021202220230100200300400
Additional affiliations
July 2014 - present
Universidade do Sul de Santa Catarina (Unisul)
Position
  • Professor of Neurosurgery
July 2014 - present
Hospital Infantil Joana de Gusmão
Position
  • Quality Assurance Specialist
July 2014 - present
Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
Position
  • Quality Assurance Specialist

Publications

Publications (182)
Article
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Purpose A C5–C8 brachial plexus root injury, also known as a T1 hand, is associated with paralysis of shoulder abduction or external rotation and elbow flexion, accompanied by variable elbow, wrist, thumb, or finger extension deficits. We report the results of reconstruction for C5–C8 brachial plexus paralysis in 52 patients operated upon within 12...
Article
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Purpose In cases of isolated paralysis of the axillary nerve, dissection of the distal stump at the posterior deltoid border can be difficult because of scarring from an injury or previous surgery. To overcome this, we propose dissecting the anterior division of the axillary nerve (ADAN) using a deltoid-splitting approach. We investigated the anato...
Article
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Objective: The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach. Methods: Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. Results: Via the anterior arm approach, all triceps muscle heads could be d...
Article
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OBJECTIVE Identifying roots available for grafting is of paramount importance prior to reconstructing complex injuries involving the brachial plexus. This is traditionally achieved by combining input from both clinical examinations and imaging studies. In this paper, the authors describe and evaluate two new clinical tests to study long thoracic ne...
Cover Page
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Nerve Transfers: Paralysis and Tetraplegia Fresh Cadaver Course Barcelone September 03-04, 2021 II Bertelli's Preferred Techniques!
Chapter
Lower-type injuries of the brachial plexus are not common. We have identified three types of paralysis: (a) C8–T1 root injury (30% of the cases), finger flexion is very weak and needs reconstruction; (b) C7–T1 root injury (60% of the cases), finger flexion-extension and intrinsic muscle of the hand are all paralyzed; and (c) C6–T1 root injury (10%...
Chapter
Root nerve surgical exploration and grafting is technically more demanding than nerve transfers, but mastering it is mandatory to optimize the outcomes of brachial plexus reconstruction. For preoperative planning for BPI, we recommend combining Tinel’s sign, the protraction sign (in complete palsies), and a CT-myeloscan to verify C5-C6 availability...
Article
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Axonal count is the base for efficient nerve transfer; despite its capital importance, few studies have been published on human material, most research approaches being performed on experimental animal models of nerve injury. Thus, standard analysis methods are still lacking. Quantitative data obtained have to be reproducible and comparable with pu...
Article
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Objective: The purpose of this study was to describe the anatomy of donor and recipient median nerve motor branches for nerve transfer surgery within the cubital fossa. Methods: Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. Results: In the cubital fossa, the first branch was a...
Article
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Purpose To evaluate claw deformity correction following anterior interosseous nerve (AIN) end-to-end transfer to the deep motor branch of the ulnar nerve (DMBUN) in high ulnar nerve injuries. Methods Eleven patients were retrospectively evaluated for metacarpophalangeal joint hyperextension and proximal interphalangeal joint extension lag in the f...
Article
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Precise pre- and postoperative assessments are fundamental to recording the quality of recovery after ulnar nerve repair. Because of its imprecision, manual muscle testing is being replaced by dynamometry to measure grasping and key-pinch strengths. However, both grasping and key pinch are dependent not only on the ulnar nerve but also the median a...
Article
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Lower-type brachial plexus injuries (BPI) are uncommon, and traditional reconstruction with tendon transfer procedures generally produce mediocre results. However, the advent of nerve transfers has rejuvenated the reconstructive options for peripheral nerve and spinal cord injuries. In this paper, we report the case 32 year-old patient with a C7-T1...
Article
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Purpose With nerve or tendon surgery, the results of thumb reconstruction to treat radial nerve paralysis are suboptimal. The goals of this study were to describe the anatomy of the deep branch of the posterior interosseous nerve (PIN) to the thumb extensor muscles (DBPIN), and to report the clinical results of transferring the distal anterior inte...
Article
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Purpose: With radial nerve lesions, the results of nerve transfers and how they objectively compare with the outcomes of tendon transfers remain unstudied. We compared the results after nerve transfer in patients with less than 12 months since radial nerve injury with the results after tendon transfer in patients not eligible for nerve surgery bec...
Article
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Objective: The authors describe the anatomy of the motor branches of the pronator teres (PT) as it relates to transferring the nerve of the extensor carpi radialis brevis (ECRB) to restore wrist extension in patients with radial nerve paralysis. They describe their anatomical cadaveric findings and report the results of their nerve transfer techni...
Article
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Purpose: Clinical deficits might vary, depending on whether an ulnar nerve lesion is above or below the elbow. Lack of strength and clawing are common manifestations of ulnar nerve paralysis. However, the magnitude of strength deficit relating to different pinch patterns and the rate and range of proximal interphalangeal extension deficits are poo...
Article
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Reconstruction of elbow extension is a first priority in the surgical management of patients with tetraplegia. Traditionally, posterior deltoid and biceps to triceps muscle transfers were used, but in recent years, nerve transfers have become the preferred choice of a few surgeons. However, nerve transfer reconstruction failures exist, often relate...
Article
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Introduction Posttraumatic brachial plexus (BP) palsy was used to be treated by reconstruction with nerve grafts. For the last two decades, nerve transfers have gained popularity and believed to be more effective than nerve grafting. The aim of this systematic review was to compare elbow flexion restoration with nerve transfers or nerve grafting af...
Article
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Purpose: To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). Methods: Twelve patients younger than 18 years with scaphoid nonunion, who underwent a VTMPF procedure without bone grafting, were included for this prospectiv...
Article
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We aimed to evaluate the abduction and adduction of the little finger based on a new clinical test in the context of ulnar nerve lesions. We tested little finger abduction and adduction in 34 patients with an isolated ulnar nerve injury and 20 patients with cubital tunnel syndrome. With their forearms supinated, patients were asked to fully abduct...
Article
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Purpose: With ulnar nerve injuries, paralysis of the first dorsal interosseous (FDI) and the adductor pollicis (ADP) muscles weakens pinch. The likelihood that these muscles will be reinnervated following ulnar nerve repair around the elbow is very low. To overcome this obstacle, we propose a more distal repair: transferring the opponens pollicis...
Article
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Purpose: To report the results of radial nerve grafting in 7 children who sustained a radial nerve injury following a distal humeral fracture. Methods: Seven children, mean age 6 years (range, 4-11 years), underwent nerve grafting for radial nerve injuries following distal humeral fractures. The mean interval between injury and surgery was 6.7 m...
Article
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Purpose: To report the clinical outcomes of elbow flexion reconstruction using a reverse free gracilis muscle flap plus Steindler flexorplasty in patients with previously failed reconstruction of extended upper-type brachial plexus paralysis. Methods: Twenty-four male patients were reoperated upon an average of 45 months (SD, ± 45 months) after...
Article
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A 40-year-old woman presented with Madelung deformity and severe arthritic changes at both the radiocarpal and the distal radioulnar joints. She was treated by using her lunate as an osteochondral graft into the radius allowing reconstruction of the lunate fossa. The scaphoid and triquetrum were removed concomitantly and a Sauve-Kapandji procedure...
Article
Purpose: Through an anatomical review, the primary aim of this study was to delineate the dorsal thumb metacarpal (TM) periosteal branches of the radial artery (RA). In addition, we report here the clinical utility of a vascularized TM periosteal pedicled flap (VTMPF), supplied by the first dorsal metacarpal artery (FDMA), in a complex case of sca...
Article
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Purpose: In high median nerve repairs, thenar muscle reinnervation is impossible because of the long distances over which axons must regenerate. To overcome this obstacle, we propose transferring the abductor digiti quinti motor branch (ADQMB) to the thenar branch of the median nerve (TBMN). Methods: We used 10 embalmed hands for anatomical and...
Article
Introduction/hypothesis: The purpose of this study is to determine the mid/long term shoulder function in patients with complete deltoid paralysis and intact rotator cuff. 27 patients with at least 2-years FU were included. Materials and methods: Outcome measures included pain, range of motion(including the swallowtail test, STT), deltoid extens...
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Purpose: To report the distribution of the different patterns of stretch brachial plexus injuries (BPIs) in a retrospective cohort of patients operated at our institution during an 11-year period. Methods: From September 2002 to June 2012, we evaluated and operated on 565 patients with traction injuries of the brachial plexus. Average age was 26...
Article
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Background: The aim of our study was to objectively test sensibility on the dorsal side of the hand in patients with radial nerve injury, to document deficits and to detect if surgery for sensory reconstruction is needed. Methods: Nineteen patients of mean age 31 ± 10 years were examined at a mean of 26.4 ± 27.8 months post radial nerve injury....
Article
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We report the study of the anatomical feasibility of transferring the nerve to the brachialis muscle to the upper medial head motor branch that innervate the triceps, and outcomes of such transfers in restoring elbow extension in five patients with posterior cord lesion of the brachial plexus. The length of the branches to the brachialis muscle mea...
Article
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Purpose: With spinal cord injuries, muscles below the level of the lesion remain innervated despite the absence of volitional control. This persistent innervation protects against denervation atrophy and may allow for nerve transfers to treat long-standing lesions within the spinal cord. We tested the hypothesis that in chronic spinal cord lesions...
Article
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OBJECTIVE The purpose of this paper was to report the authors' results with finger flexion restoration by nerve transfer in patients with tetraplegia. METHODS Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The pat...
Article
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Objectives: Absence of sensation in C8-T1 dermatome is a common finding in midcervical spinal cord injury. The goal was to restore sensation on the C8-T1 dermatomes by transferring sensory nerves with afferents on C5-C6 roots. Methods: A mean 10 months post spinal cord injury, we operated on 10 upper limbs from 5 tetraplegics averaging 23 years...
Article
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This article describes the clinically significant motor and sensory deficits that follow high median nerve injuries and addresses the indications, limitations, and outcomes of nerve transfers, when striving to overcome the deficits these patients experience. Preferred surgical reconstructive strategy using motor and sensory nerve transfers, and sur...
Article
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OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002–2012), 257 patients with total brachial plexus palsy were opera...
Article
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The aim of this study was to describe the mechanisms involved in stretch injuries of the brachial plexus. One hundred and fifty consecutive patients with supraclavicular brachial plexus injuries (BPI) were asked about the mechanism of injury during the actual injury event, particularly about the type of trauma to their shoulder, shoulder girdle and...
Article
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Purpose To describe clinically apparent motor and sensory deficits in a cohort of 11 patients with isolated injury of the median nerve above the elbow and compare them against similar cases reported in the literature. Method Eleven patients of mean age 30 years (SD � 14 years; 6 males, 5 females) were examined a mean of 21 weeks (SD � 16 weeks) aft...
Article
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OBJECTIVE Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was...
Article
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Purpose: To analyze the anatomical feasibility of transferring a motor branch nerve to the flexor carpi ulnaris (FCU) to the triceps upper medial head motor branch (UMHM) and to report the resultant outcome of the restoration of elbow extension in 5 patients with extensive brachial plexus injury. Methods: The ulnar and radial nerves were dissect...
Article
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OBJECT The objective of this study was to report the results of pronator quadratus (PQ) motor branch transfers to the extensor carpi radialis brevis (ECRB) motor branch to reconstruct wrist extension in C5–8 root lesions of the brachial plexus. METHODS Twenty-eight patients, averaging 24 years of age, with C5–8 root injuries underwent operations a...
Article
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OBJECT Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients’ average age was 2...
Article
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The aim of this study was to validate direct tendon palpation during agonist contraction and antagonist co-contraction as a method to assess wrist flexor and extensor muscle function in cases of upper limb paralysis. On one occasion, five doctors examined 17 patients with partial paralysis of the upper limb resulting from brachial plexus or cervica...
Article
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To report our experiences reconstructing thumb and finger flexion in patients with extensive palsy of the upper limb by transferring the radial nerve branch to the extensor carpi radialis brevis (ECRB) to the anterior interosseous nerve (AIN). Within 8 months after injury, 4 patients with either a combined high median/ulnar nerve palsy or C7-T1 bra...
Article
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PurposeTo report the clinical outcomes of thoracodorsal nerve (TDN) transfers to the triceps motor branches for elbow extension restoration in patients with partial brachial plexus injuries (BPI).Methods Eight male patients of mean age 23 years and suffering from a partial BPI underwent direct coaptation of the TDN to the nerve of the upper medial...
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Object: The objective of this study was to report the results of elbow, thumb, and finger extension reconstruction via nerve transfer in midcervical spinal cord injuries. Methods: Thirteen upper limbs from 7 patients with tetraplegia, with an average age of 26 years, were operated on an average of 7 months after a spinal cord injury. The posteri...
Article
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Surgeons believe that in high ulnar nerve lesion distal interphalangeal joint (DIP) flexion of the ring and little finger is abolished. In this article, we present the results of a study on innervation of the flexor digitorum profundus of the ring and little fingers in five patients with high ulnar nerve injury and in 19 patients with a brachial pl...
Article
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Purpose To report the clinical results of thoracodorsal nerve (TDN) transfer to the biceps nerve for elbow flexion restoration in infraclavicular brachial plexus injuries. Methods Five male patients, mean age 33 years and affected with infraclavicular brachial plexus injuries, underwent a direct coaptation of the TDN to the nerve to the biceps an a...
Article
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Hand pain is a major complaint in 80% of the patients with complete brachial plexus palsy; and, in 80% of these patients, the C5 root is ruptured and the C6-T1 roots avulsed from the spinal cord. It has been suggested that pain in brachial plexus injuries may not arise from avulsed roots, but rather from ruptured roots. Traditionally the C5 root de...
Article
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To report our results with reconstruction of the axillary nerve by transferring the branch to the triceps lower medial head and anconeus to the anterior division of the axillary nerve. This study included 9 patients with isolated injury of the axillary nerve. Their average age ± SD was 35 ± 9 years, and the mean interval ± SD between injury and sur...
Article
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The rat models currently employed for studies of nerve regeneration present distinct disadvantages. We propose a new technique of stretch-induced nerve injury, used here to evaluate the influence of gabapentin (GBP) on nerve regeneration. Male Wistar rats (300 g; n=36) underwent surgery and exposure of the median nerve in the right forelimbs, eithe...
Article
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A 39-year-old tetraplegic patient had paralysis of elbow, thumb, and finger extension and thumb and finger flexion. We transferred axillary nerve branches to the triceps long and upper medial head motor branches, supinator motor branches to the posterior interosseous nerve, and brachioradialis tendon to the flexor pollicis longus and flexor superfi...
Article
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Purpose: To report the clinical results of a free gracilis muscle transfer to finger and thumb extensors reinnervated by supinator muscle motor branches in patients with longstanding C7-T1 root avulsion. Methods: Between January 2010 and January 2011, 3 young adult patients with traumatic C7-T1 brachial plexus palsies had gracilis transfer to th...
Article
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In brachial plexus injuries, though nerve transfers and root grafts have improved the results for shoulder and elbow reconstruction, wrist extension has received little attention. We operated on three young patients with C5-C8 root injuries of the left brachial plexus, each operated upon within 6 months of trauma. For wrist extension reconstruction...
Article
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Stretch injuries of the C5-C7 roots of the brachial plexus traditionally have been associated with palsies of shoulder abduction/external rotation, elbow flexion/extension, and wrist, thumb, and finger extension. Based on current myotome maps we hypothesized that, as far as motion is concerned, palsies involving C5-C6 and C5-C7 root injuries should...
Article
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: In extended upper-type lesions of the brachial plexus, nerve transfers and root grafting have improved the results of shoulder and elbow reconstruction. However, wrist extension reconstruction has received little attention. : In 20 cadaveric upper limbs, we dissected the anterior interosseous nerve and extensor carpi radialis brevis motor branch....
Article
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Background: Recovery from peripheral nerve repair is frequently incomplete. Hence drugs that enhance nerve regeneration are needed clinically. Objectives: To study the effects of nandrolone decanoate in a model of deficient reinnervation in the rat. Methods: In 40 rats, a 40-mm segment of the left median nerve was removed and interposed betwee...
Article
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We undertook a brachialis to triceps nerve transfer to restore elbow extension in a 53-year-old man 5 months after he sustained a spine injury that resulted in a central cord syndrome. Within 3 months of surgery, the patient had recovered active elbow extension and had M3 level strength, which increased to M4 and 5 kg of strength by 12 months posto...
Article
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To report the results of sensory nerve transfers to reconstruct sensation on the ulnar side of the hand in lower-type palsies of the brachial plexus. From 2007 to 2009, we operated on 6 men and 2 women with a lower-type injury of the brachial plexus and observed them for a minimum of 24 months. The mean interval between the injury and surgery was 8...