From January 2000 to March 2004, 57 patients (53 males, 4 females, aged between 15 and 60 years old) with upper root injuries or complete brachial plexus injuries were surgical treated by neurotization from spinal accessory nerve to the musculo-cutaneous nerve for restoration of elbow flexion in the Trauma and Orthopedics Hospital of HoChiMinh city. Following-up lasted 12-24 months. The results: good result in restoration of elbow flexion MRC3 or more in 72% and the earliest MRC3 gained time was 8 months, the time became to zoom in 2 muscle tips was 6 months. The early neurotization surgery and young people were important factors for good results. Although a less re-examination patients, recovery results were good. It solved somewhat psychological complex for patients
Brachial Plexus ; Nerve Transfer ; Brachial Plexus

No abstract available.
Paralysis* ; Radial Nerve* ; Tendon Transfer* ; Tendons*

We have described the intercostal nerve transfer to musculocutaneous nerve for three patients with root-avulsion type brachial plexus complete injuries. Surgical technique and some considerations about the operation have been discussed.
Brachial Plexus* ; Humans ; Intercostal Nerves* ; Musculocutaneous Nerve ; Nerve Transfer

The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (<3 weeks duration), intermediate duration facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy.
Cosmetics ; Decompression ; Facial Nerve ; Facial Paralysis ; Humans ; Muscles ; Nerve Transfer

This study was carried out to evaluate the quantity of the nerve fiber of the terminal branches of the typical brachial plexus in the 6 sides of the Korean adults. The dorsal scapular nerve, which is derived from ramus of the brachial plexus, was comprised of C5 and participating nerve fiber was 355+/-180. The long thoracic nerve was composed of C5, C6 and C7, and was mainly originated from C6, and participating nerve fiber was 743+/-346. The nerves, which are branched out from trunk, nerve to subclavius muscle was composed of C5 and participating quantity was 242+/-71. The suprascapular nerve was comprised of C5 and C6, and the nerve fiber was mainly derived from C5 (1,942+/-505). The nerve, which is originated from proximal portion of the cord, the lateral pectoral nerve was constituted of C5, C6 and C7. The main component was C7 as the 2,917+/-785 nerve fiber. The medial pectoral nerve was made with C8 and T1. The main component was C8 as the 964+/-430 nerve fiber. The upper subscapular nerve was derived from C5 and C6. The nerve fiber was 1,179+/-92 in C5, mainly participated. The Lower subscapular nerve was constituted of C5, C6 and C7. C6 was the main component and contributing nerve fiber was 1,070+/-390 in C6, principal component. The thoracodorsal nerve was formed by C6, C7 and C8. The chief component was C7, contributed of 2,335+/-324. The nerves, which are came out from the distal portion of the cord, musculocutaneous nerve was derived from the C5, C6 and C7. The C6 was principal component, and was joined with 4,009+/-1,883. The median nerve was contributed from C5 to T1. The chief component was C7 added with 9,651+/-2,663. The ulnar nerve was composed of C7, C8 and T1. The C8 was the main component comprised of 10,075+/-1,473. The medial brachial and antebrachial cutaneous nerves was constituted of C8 and T1. In the both nerves, the main component was T1 participated with 1,752+/-390, 3,080+/-1,140 respectively. The radial nerve was composed of C5 to T1. The C7 was principal component added with 7,958+/-2,333. The axillary nerve was made up C5 and C6. In the nerve, the both spinal segments were similarly participated to the nerve. This results could be applied for the injuries and neurotization procedure of the terminal nerves of the brachial plexus.
Brachial Plexus ; Median Nerve ; Muscles ; Musculocutaneous Nerve ; Nerve Fibers ; Nerve Transfer ; Porphyrins ; Radial Nerve ; Spinal Nerves ; Thoracic Nerves ; Ulnar Nerve

OBJECTIVETo comprehend the anatomic characteristics and correlations between the accessory nerve and the phrenic nerve in the adult corpses.

METHODSThe bilateral accessory nerves, phrenic nerves, and their branches of 20 adult corpses (38 sides) were underwent exposure. The morphologic data of the accessory nerves and the phrenic nerves above clavicle were measured. In addition, the minimal and maximal distances from several points on the accessory nerve to the full length of the phrenic nerve above clavicle were measured. Then, the number of motor nerve fibers on different locations of the nerves utilizing the method of immunohistochemistry were counted and compared.

RESULTThe accessory nerves after sending out the sternocleido-mastoid muscular branches were similar in the morphologic data with the phrenic nerves. Meanwhile, the accessory nerve had a coiled appearance within this geometrical area. The possibly minimal distance between the accessory nerve and phrenic nerve was (3.19 ± 1.23) cm, and the possibly maximal distance between the starting point of accessory nerve and the end of the phrenic nerve above clavicle was (8.71 ± 0.75) cm.

CONCLUSIONSThe accessory nerve and the phrenic nerve are similar in the anatomic evidences and the number of motor nerve fibers. And the length of accessory nerve is sufficiently long to connect with phrenic nerve as needed. It is possible to suture them without strain directly.

Accessory Nerve ; anatomy & histology ; surgery ; Adult ; Female ; Humans ; Male ; Nerve Transfer ; Phrenic Nerve ; anatomy & histology ; surgery

Background: In the procedure of tendon transfer to treat low radial nerve palsy, recovering movement amplitude for toes is not difficult. It is more important to select the appropriate motive muscle. Previously, pillar muscle was commonly used as motivation for stretching fingers, but many authors opposed this because it\u2019s affecting the function of the hand. Objectives: To evaluate the clinical features of low radial nerve palsy and the outcomes of the treatment of non-recoverable low radial nerve palsy by Smith's procedure of tendon transfer. Subjects and methods: 36 patients suffering from irreversible low radial nerve palsy were treated by Smith's procedure of tendon transfer from Jan 2000 to Jan 2008. Mean follow-up was 23 months. Outcomes assessment was based on Tajima's criteria. Results: All 30 patients were satisfied with the operation and were greatly improved both their functional and aesthetic aspects. In term of biomechanics, the Flexor Carpi Radialis (FCR) is more suitable for reconstruction of the Extensor Digitorum Communis (EDC) in comparison with the flexor carpi ulnaris (FeU) or the power density spectrum. The patients showed good movements of the wrist and fingers/ the thumb moved independently with satisfactory extension and abduction/ the grip strength was rapidly improving. Conclusions: The use of the FCR for reconstruction of the EDC is a suitable choice and Smith's procedure of tendon transfer is a good procedure for the treatment of irreversible radial nerve palsy.
procedure of tendon transfer ; Non-recoverable low radial nerve palsy

The brachial plexus injury causes a catastrophic loss of functions of the corresponding upper extremity. However, for a long time, it must have been treated by conservative methods. Recently, with the development of the microsurgery, the brachial plexus lesions were begun to be treated by surgical means, such as neuroiysis, interfascicuiar nerve graft, or neurotization. We experienced seven cases, managed by interfaseicular nerve graft under the operating microscope, and here we presented four cases with the over-one-year results after operations.
Brachial Plexus ; Microsurgery ; Nerve Transfer ; Transplants ; Upper Extremity

INTRODUCTION: In patients with delayed presentation between 6 to 12 months, surgical treatment guidelines are not well defined in brachial plexus injury. Still, several authors have agreed that functional outcomes in patients treated within six months from the date of injury have the best results. Nerve transfers are still considered one of the treatment options in the said subset of patients even after six months. In contrast, a primary Steindler flexorplasty, or proximal advancement of the flexor-pronator group, is an ideal technique for elbow flexion with an elapsed time from injury >6 to 9 months. OBJECTIVE: The purpose of this investigation was to compare the clinical outcome s of nerve transfers versus modified Steindler flexorplasty for the restoration of elbow flexion in upper type brachial plexus injuries (BPI). METHODS: A retrospective review of 28 patients who underwent nerve transfers (NT) and 12 patients who underwent modified Steindler flexorplasty (MSF) was done to determine the outcome of treatments. The manual muscle testing using the Medical Research Council scaling system, Visual Analog Scale for pain, active range of motion, and Disabilities of the Arm, Shoulder and Hand form scores were taken as dependent variables. RESULTS: The NT group had a median age of 27.5 years, with 26 men, a median surgical delay of 5.6 months, and a median follow-up of 33 months. Twenty out of 28 patients (71%) had ≥M3 with a median range of 117.6° elbow flexion motion. Median postoperative DASH (n=16) and VAS scores were 29.2 and 3, respectively. For the MSF patients, the median age was 27 years, including ten men, the median surgical delay was 12 months, and the median follow-up was 18.4 months. All the 12 patients had ≥M3, with a median range of motion of 106°. The median postoperative DASH score (n=5) and VAS score were 28.3 and 0, respectively. In the NT group, 73.3% (11/15) achieved ≥M3 elbow flexion if the operation was done in <6 months. CONCLUSION: Nerve transfers and the modified Steindler procedure are still excellent options for successful elbow flexion reanimation in patients with brachial plexus injuries. Our results also showed that those with surgical delays of less than six months had the highest rate of achieving ≥M3 elbow flexion strength in the nerve transfer group.
Nerve Transfer ; Elbow ; Brachial Plexus ; Elbow Joint ; Range of Motion, Articular

OBJECTIVES: The primary objective of this study was to define the anatomy of the musculocutaneous nerve as it innervates the biceps and brachialis muscles in relation to nerve transfer surgery in brachial plexus injury.

METHODS: Surgical dissection of the musculocutaneous nerve of both upper extremities of 34 embalmed cadavers was performed to define the anatomy of the musculocutaneous nerve as it supplies the biceps and the brachial muscles. Among the data that we noted were the distance where the branch of the biceps and branchialis took off from the musculocutaneous nerve from the coracoids, which was the bony landmark.

RESULTS: There were 17 males and 17 females with a total of 65 musculocutaneous nerve to biceps muscle had an average distance of 10.9cm and a median of 11.0cm±1.83cm (range, 6.5-14.2 cm) from the coracoid. The branching of musculocutaneous nerve to the brachialis had an average distance of 15.1 cm and a median 15.5cm±1.72cm (range, 12.7-21.0cm) from the coracoid. Transferring the fascicles of the ulnar nerve to the biceps branch and a fascicle of the median nerve to the brachialis branch is fairly easy since both nerves are within the vicinity of respective recipient site.

CONCLUSION: The anatomy of the musculocutaneous nerve as it supplies the elbow flexors is fairly consistent and there is little discrepancy between cadaveric specimens. Human ; Male ; Female ; Musculocutaneous Nerve ; Ulnar Nerve ; Median Nerve ; Elbow ; Nerve Transfer ; Elbow Joint ; Brachial Plexus ; Embalming ; Cadaver