Nerve transfer to deltoid muscle using the nerve to the long head of the triceps. Part II: A report of 7 cases

Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand.
The Journal Of Hand Surgery (Impact Factor: 1.67). 08/2003; 28(4):633-8. DOI: 10.1016/S0363-5023(03)00199-0
Source: PubMed


This study reports the results of nerve transfer to the deltoid muscle using the nerve to the long head of the triceps.
Seven patients with an average age of 25 years with loss of shoulder abduction secondary to upper brachial plexus injuries had nerve transfer using the nerve to the long head of the triceps to the anterior branch(es) of the axillary nerve through the posterior approach. The spinal accessory nerve was used simultaneously for nerve transfer to the suprascapular nerve. The follow-up period ranged from 18 to 28 months (average, 20 mo).
All patients recovered deltoid power against resistance (M4) at the last follow-up evaluation. Useful functional recovery was achieved in all 7 patients; 5 had excellent recoveries and 2 had good results. The average shoulder abduction was 124 degrees. No notable weakness of elbow extension was observed.
This method is a reliable and effective procedure for deltoid reconstruction in brachial plexus injury (upper-arm type) and should be combined with spinal accessory nerve transfer to the suprascapular nerve to obtain good shoulder abduction.

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    • "Axillary nerve neurotisation through the anterior approach not only requires nerve grafts but also results in dilution of nerve fibers reaching the deltoid muscle.[19] A posterior approach[1520] allows the transfer of a long head of triceps branch (radial nerve) to the anterior branch of the axillary nerve that innervates the anterior and middle parts of the deltoid muscle [Figure 4]. This transfer is again close to the target muscle (deltoid) and avoids the misdirection of the regenerated axons into the cutaneous branch and teres minor. "
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    ABSTRACT: Management of brachial plexus injury is a demanding field of hand and upper extremity surgery. With currently available microsurgical techniques, functional gains are rewarding in upper plexus injuries. However, treatment options in the management of flail and anaesthetic limb are still evolving. Last three decades have witnessed significant developments in the management of these injuries, which include a better understanding of the anatomy, advances in the diagnostic modalities, incorporation of intra-operative nerve stimulation techniques, more liberal use of nerve grafts in bridging nerve gaps, and the addition of new nerve transfers, which selectively neurotise the target muscles close to the motor end plates. Newer research works on the use of nerve allografts and immune modulators (FK 506) are under evaluation in further improving the results in nerve reconstruction. Direct reimplantation of avulsed spinal nerve roots into the spinal cord is another area of research in brachial plexus reconstruction.
    No preview · Article · May 2014 · Indian Journal of Plastic Surgery
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    • "Radial nerve to axillary nerve – This was described in 2003. The authors (30-32) demonstrated through an anatomical and clinical study that it was possible to obtain a branch of the radial nerve for suturing to the posterior branch of the injured axillary nerve (Figure 1. Subsequent clinical studies demonstrated good results with this technique (approximately 124 degrees of abduction), especially if in association with neurotization of the spinal accessory nerve with the suprascapular nerve (33). "
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    ABSTRACT: Brachial plexus injuries, in all their severity and complexity, have been extensively studied. Although brachial plexus injuries are associated with serious and often definitive sequelae, many concepts have changed since the 1950s, when this pathological condition began to be treated more aggressively. Looking back over the last 20 years, it can be seen that the entire approach, from diagnosis to treatment, has changed significantly. Some concepts have become better established, while others have been introduced; thus, it can be said that currently, something can always be offered in terms of functional recovery, regardless of the degree of injury. Advances in microsurgical techniques have enabled improved results after neurolysis and have made it possible to perform neurotization, which has undoubtedly become the greatest differential in treating brachial plexus injuries. Improvements in imaging devices and electrical studies have allowed quick decisions that are reflected in better surgical outcomes. In this review, we intend to show the many developments in brachial plexus surgery that have significantly changed the results and have provided hope to the victims of this serious injury.
    Full-text · Article · Mar 2013 · Clinics (São Paulo, Brazil)
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    • "Dual nerve transfer Leechavengvongs et al. 143 (2006) Avulsion of C5-C6 SAN, RN SSN, axillary 15 87 100 115 (45-160) Leechavengvongs et al. 144 (2003) Avulsion of C5-C6 SAN, RN SSN, axillary 7 100 100 124 (70-160) Uerpairojkit et al. 172 (2009) "
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    ABSTRACT: In treating patients with brachial plexus injury, there are no comparative data on the outcomes of nerve grafts or nerve transfers for isolated upper trunk or C5-C6-C7 root injuries. The purpose of our study was to compare, with systematic review, the outcomes for modern intraplexal nerve transfers for shoulder and elbow function with autogenous nerve grafting for upper brachial plexus traumatic injuries. PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for studies in which patients had surgery for traumatic upper brachial plexus palsy within one year of injury and with a minimum follow-up of twelve months. Strength and shoulder and elbow motion were assessed as outcome measures. The Fisher exact test and Mann-Whitney U test were used to compare outcomes, with an alpha level of 0.05. Thirty-one studies met the inclusion criteria. Two hundred and forty-seven (83%) and 286 (96%) of 299 patients with nerve transfers achieved elbow flexion strength of grade M4 or greater and M3 or greater, respectively, compared with thirty-two (56%) and forty-seven (82%) of fifty-seven patients with nerve grafts (p < 0.05). Forty (74%) of fifty-four patients with dual nerve transfers for shoulder function had shoulder abduction strength of grade M4 or greater compared with twenty (35%) of fifty-seven patients with nerve transfer to a single nerve and thirteen (46%) of twenty-eight patients with nerve grafts (p < 0.05). The average shoulder abduction and external rotation was 122° (range, 45° to 170°) and 108° (range, 60° to 140°) after dual nerve transfers and 50° (range, 0° to 100°) and 45° (range, 0° to 140°) in patients with nerve transfers to a single nerve. In patients with demonstrated complete traumatic upper brachial plexus injuries of C5-C6, the pooled international data strongly favors dual nerve transfer over traditional nerve grafting for restoration of improved shoulder and elbow function. These data may be helpful to surgeons considering intraoperative options, particularly in cases in which the native nerve root or trunk may appear less than optimal, or when long nerve grafts are contemplated.
    Full-text · Article · May 2011 · The Journal of Bone and Joint Surgery
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