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Chen X, Guo J, Zhou Y, Lao J, Zhao X, Rui J. Modified contralateral C7 transfer to restore ulnar nerve function without sacrificing median nerve recovery: an experimental study. J Hand Surg Eur Vol 2023; 48:731-737. [PMID: 37203387 DOI: 10.1177/17531934231170103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Contralateral C7 (cC7) transfer is a technique used in patients with total brachial plexus avulsion. An ulnar nerve graft (UNG) is usually used, as intrinsic function is not expected to be restored due to length of reinnervation required. In this study, we attempted to improve intrinsic function recovery by preserving the deep branch of the ulnar nerve (dbUN) and reanimating it with the anterior interosseous nerve (AIN) after cC7 transfer. Fifty-four rats were divided into the following three groups: Group A, traditional cC7 transfer to the median nerve with a UNG; Group B, cC7 transfer preserving and repairing the dbUN with the terminal branch of the AIN; Group C, same as Group B; however, the dbUN was coapted after 1 month with the AIN. At 3, 6 and 9 months postoperatively, the results of electrodiagnostic and histomorphometric examinations of the interosseous muscle were significantly better in Groups B and C, without affecting AIN recovery. In conclusion, the modified cC7 transfer technique can potentially improve intrinsic function recovery without affecting median nerve recovery.
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Affiliation(s)
- Xi Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, P. R. China
- NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai, P. R. China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, P. R. China
| | - Jinding Guo
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, P. R. China
- NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai, P. R. China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, P. R. China
| | - Yingjie Zhou
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, P. R. China
- NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai, P. R. China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, P. R. China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, P. R. China
- NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai, P. R. China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, P. R. China
| | - Xin Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, P. R. China
- NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai, P. R. China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, P. R. China
| | - Jing Rui
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, P. R. China
- NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai, P. R. China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, P. R. China
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Liang S, Liu YZ, Hu XQ, Zhao X, Lao J. Restoration of intrinsic hand function by superficial radial nerve: an anatomical study. BMC Musculoskelet Disord 2023; 24:628. [PMID: 37532990 PMCID: PMC10394765 DOI: 10.1186/s12891-023-06758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The contralateral seventh cervical (cC7) nerve root transfer represents a cornerstone technique in treating total brachial plexus avulsion injury. Traditional cC7 procedures employ the entire ulnar nerve as a graft, which inevitably compromises its restorative capacity. OBJECTIVE Our cadaveric study seeks to assess this innovative approach aimed at preserving the motor branch of the ulnar nerve (MBUN). This new method aims to enable future repair stages, using the superficial radial nerve (SRN) as a bridge connecting cC7 and MBUN. METHODS We undertook a comprehensive dissection of ten adult cadavers, generously provided by the Department of Anatomy, Histology, and Embryology at Fudan University, China. It allowed us to evaluate the feasibility of our proposed technique. For this study, we harvested only the dorsal and superficial branches of the ulnar nerve, as well as the SRN, to establish connections between the cC7 nerve and recipient nerves (both the median nerve and MBUN). We meticulously dissected the SRN and the motor and sensory branches of the ulnar nerve. Measurements were made from the reverse point of the SRN to the wrist flexion crease and the coaptation point of the SRN and MBUN. Additionally, we traced the MBUN from distal to proximal ends, recording its maximum length. We also measured the diameters of the nerve branches and tallied the number of axons. RESULTS Our modified approach proved technically viable in all examined limbs. The distances from the reverse point of the SRN to the wrist flexion crease were 8.24 ± 1.80 cm and to the coaptation point were 6.60 ± 1.75 cm. The maximum length of the MBUN was 7.62 ± 1.03 cm. The average axon diameters in the MBUN and the anterior and posterior branches of the SRN were 1.88 ± 0.42 mm、1.56 ± 0.38 mm、2.02 ± 0.41 mm,respectively. The corresponding mean numbers of axons were 1426.60 ± 331.39 and 721.50 ± 138.22, and 741.90 ± 171.34, respectively. CONCLUSION The SRN demonstrated the potential to be transferred to the MBUN without necessitating a nerve graft. A potential advantage of this modification is preserving the MBUN's recovery potential.
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Affiliation(s)
- Shuo Liang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yu-Zhou Liu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xiao-Qian Hu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xin Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.
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Chen X, Guo J, Zhou Y, Lao J, Zhao X, Rui J. A rat model of modified contralateral C7 transfer permitting ulnar nerve recovery. J Plast Reconstr Aesthet Surg 2023; 81:122-129. [PMID: 37137193 DOI: 10.1016/j.bjps.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/07/2023] [Accepted: 03/15/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Contralateral C7 transfer (cC7) is an important treatment for total brachial plexus avulsion (TBPA), which sacrifices the recovery of the ulnar nerve (UN). The present study aimed to introduce an animal model of modified cC7 that preserved the deep branch of ulnar nerve (dbUN) and verify its feasibility. METHODS Anatomical study: Lengths, diameters, and axon counts of dbUN and anterior interosseous (AIN) branches in six rats were measured. In vivo surgery: 18 rats were divided into three groups. Group A: Traditional cC7. Group B: Modified cC7 finished in one stage. Group C: Modified cC7 and AIN branch anastomosed with dbUN one month after the first stage. Electrophysiological examinations, muscle wet weight, muscle cross-sectional areas, and nerve axon counts were evaluated six months postoperatively. RESULTS Anatomical study: The distances from dbUN and AIN branches to the midpoint of the inner and outer epicondyles connection of the humerus, diameters, and axon numbers of dbUN and AIN branches were analyzed, then AIN terminal branch (tbAIN) was anastomosed with dbUN. In vivo surgery: The differences in median nerve fiber counts were not significant. There were more UN axons in group A than in groups B and C. In electrophysiological examinations, muscle wet weight and cross-sectional area of the flexor digitorum profundus showed no significant difference, but the second interosseus cross-sectional areas in groups B and C were significantly larger than in group A. CONCLUSIONS This study established an animal model of preserving dbUN in cC7 and verified its feasibility. The possibility of restoring dbUN was established.
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Affiliation(s)
- Xi Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, PR China; NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai 200040, PR China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200040, PR China
| | - Jinding Guo
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, PR China; NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai 200040, PR China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200040, PR China
| | - Yingjie Zhou
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, PR China; NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai 200040, PR China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200040, PR China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, PR China; NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai 200040, PR China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200040, PR China
| | - Xin Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, PR China; NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai 200040, PR China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200040, PR China
| | - Jing Rui
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, PR China; NHC Key Laboratory of Hand Reconstruction (Fudan University), Shanghai 200040, PR China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200040, PR China.
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Rouanet M, Hu W, Letissier H, Seizeur R, Perruisseau-Carrier A. Étude anatomique sur le lambeau de carré pronateur pédiculé réinnervé pour réanimer l’opposition du pouce et application clinique. ANN CHIR PLAST ESTH 2022; 67:211-223. [DOI: 10.1016/j.anplas.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/01/2022]
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Five Reliable Nerve Transfers for the Treatment of Isolated Upper Extremity Nerve Injuries. Plast Reconstr Surg 2021; 147:830e-845e. [PMID: 33890905 DOI: 10.1097/prs.0000000000007865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article and accompanying videos, the participant should be able to: 1. Understand and apply the principles of nerve transfer surgery for nerve injuries. 2. Discuss important considerations when performing nerve transfers, such as aspects of surgical technique and perioperative decision-making. 3. Understand indications for end-to-end versus supercharged reverse end-to-side nerve transfers. 4. Understand an algorithm for treating nerve injuries to include the indications and surgical techniques of five nerve transfers commonly performed for the treatment of isolated upper extremity nerve injuries. 5. Understand the outcomes and postoperative management of the discussed nerve transfers. SUMMARY Nerve transfers are gaining wide acceptance because of their superior results in the management of many nerve injuries of the upper extremity. This article presents five nerve transfers for the treatment of isolated nerve injuries in the authors' upper extremity nerve practice that offer reliable results. Indications, surgical techniques, outcomes, and postoperative management are reviewed. To maximize functional outcomes in patients with nerve injuries, the treatment should be individualized to the patient, and the principles for nerve transfers as described herein should be considered.
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Kou YH, Yu YL, Zhang YJ, Han N, Yin XF, Yuan YS, Yu F, Zhang DY, Zhang PX, Jiang BG. Repair of peripheral nerve defects by nerve transposition using small gap bio-sleeve suture with different inner diameters at both ends. Neural Regen Res 2019; 14:706-712. [PMID: 30632512 PMCID: PMC6352590 DOI: 10.4103/1673-5374.247475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
During peripheral nerve transposition repair, if the diameter difference between transposed nerves is large or multiple distal nerves must be repaired at the same time, traditional epineurial neurorrhaphy has the problem of high tension at the suture site, which may even lead to the failure of nerve suture. We investigated whether a small gap bio-sleeve suture with different inner diameters at both ends can be used to repair a 2-mm tibial nerve defect by proximal transposition of the common peroneal nerve in rats and compared the results with the repair seen after epineurial neurorrhaphy. Three months after surgery, neurological function, nerve regeneration, and recovery of nerve innervation muscle were assessed using the tibial nerve function index, neuroelectrophysiological testing, muscle biomechanics and wet weight measurement, osmic acid staining, and hematoxylin-eosin staining. There was no obvious inflammatory reaction and neuroma formation in the tibial nerve after repair by the small gap bio-sleeve suture with different inner diameters at both ends. The conduction velocity, muscle strength, wet muscle weight, cross-sectional area of muscle fibers, and the number of new myelinated nerve fibers in the bio-sleeve suture group were similar to those in the epineurial neurorrhaphy group. Our findings indicate that small gap bio-sleeve suture with different inner diameters at both ends can achieve surgical suture between nerves of different diameters and promote regeneration and functional recovery of injured peripheral nerves.
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Affiliation(s)
- Yu-Hui Kou
- Peking University People's Hospital, Beijing, China
| | - You-Lai Yu
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Ya-Jun Zhang
- Peking University People's Hospital, Beijing, China
| | - Na Han
- Peking University People's Hospital, Beijing, China
| | | | - Yu-Song Yuan
- Peking University People's Hospital, Beijing, China
| | - Fei Yu
- Peking University People's Hospital, Beijing, China
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