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Shekouhi R, Gerhold C, Chim H. The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review. J Hand Surg Eur Vol 2024; 49:490-498. [PMID: 37684017 DOI: 10.1177/17531934231197794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
This systematic literature review of the clinical characteristics of radiation-induced brachial plexopathy and outcomes after intervention includes 30 trials with 611 patients. The mean radiation dose to the brachial plexus was 56 Gy, and the mean duration of radiation was 4 weeks. The mean time from radiation to the onset of symptoms was 35 months. The most commonly reported symptom was sensory loss (n = 323, 62%), followed by motor deficits (n = 294, 56%) and neuropathic pain (n = 284, 54%). In total, 65 (56%) patients had panplexus involvement and 51 (44%) patients had partial plexus involvement. The most common surgical procedure was neurolysis with flap coverage (n = 108, 6%), followed by neurolysis alone (n = 71, 30%). Of the 237 patients who underwent surgery, 125 (53%) reported an improvement in pain. Motor and sensory deficits were improved in 46 (19%) and 39 (16%) patients, respectively, suggesting that surgery is beneficial in relieving pain, but not as beneficial in restoring motor and sensory function.
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Affiliation(s)
- Ramin Shekouhi
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Cameron Gerhold
- College of Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Harvey Chim
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
- Lilian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
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2
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Shoukry M, Noland SS. The Role of Surgery in the Management of Radiation-Induced Brachial Plexopathy. Hand (N Y) 2023:15589447231196902. [PMID: 37715704 DOI: 10.1177/15589447231196902] [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] [Indexed: 09/18/2023]
Abstract
Radiation-induced brachial plexopathy (RIBP) is a rare long-term complication of radiation therapy often causing pain, motor deficit, and overall quality of life reduction for affected patients. While a standard treatment for RIBP is yet to be established, management consists mostly of symptom management through the use of medications and physical therapy. There is a lack of evidence regarding the efficacy of surgical treatment. Omentoplasties and other vascularized flaps are commonly discussed options for eliminating neuropathic pain associated with RIBP. However, these approaches show no meaningful improvement in motor function. While limited, current literature suggests that nerve transfers may be an option for relief of neuropathic pain as well as restoration of motor function. This review of literature explores the options available to those affected by RIBP with a focus on the role of surgery.
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Affiliation(s)
- Mira Shoukry
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Shelley S Noland
- Division of Hand & Peripheral Nerve Surgery, Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
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3
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Yin Y, Xue Y, Yang B, Ng CY, Yang C, Li F, Li W, Li B, Wang S. Outcome of Nerve Grafting for Radiation-Induced Brachial Plexopathy. Oper Neurosurg (Hagerstown) 2023; 24:55-63. [PMID: 36519879 DOI: 10.1227/ons.0000000000000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 08/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is no consensus on the optimal treatment for radiation-induced brachial plexopathy (RIBP). OBJECTIVE To present our experience of using nerve resection and autografting as a treatment strategy for this challenging condition. METHODS From September 2014 to January 2020, 8 patients with RIBP were treated with segmental nerve resection and autografting, with or without other supplementary procedures. All patients underwent sural nerve grafting to the musculocutaneous nerve. All were female with a mean age of 53 (range 38-64) years. Seven were on the left, and 1 was on the right. The mean follow-up duration was 33 (range 17-72) months. RESULTS By the final review, 7 of 8 patients regained at least antigravity elbow flexion. Four patients reached Medical Research Council (MRC) grade 4, 3 MRC grade 3, and MRC grade 2 recovery in the biceps. The mean Visual Analog Score for pain improved from 2.6 preoperatively to 0.6 postoperatively ( P = .042). CONCLUSION Nerve resection and autografting may restore satisfactory elbow flexion in patients with RIBP.
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Affiliation(s)
- Yaobin Yin
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Yunhao Xue
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Baokai Yang
- Department of Orthopaedic, People Hospital of Ningjin, Dezhou, Shandong, China
| | - Chye Yew Ng
- Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Chen Yang
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Feng Li
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Wenjun Li
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Bin Li
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Shufeng Wang
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
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4
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Morse RT, Doke K, Ganju RG, Sood S, Mavroidis P, Chen AM. Stereotactic body radiotherapy for apical lung tumors: Dosimetric analysis of the brachial plexus and preliminary clinical outcomes. Pract Radiat Oncol 2021; 12:e183-e192. [PMID: 34929402 DOI: 10.1016/j.prro.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/19/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dosimetric constraints of the brachial plexus have not yet been well-established for patients undergoing stereotactic body radiotherapy (SBRT). This study evaluated long-term experience with the treatment of early stage apical lung tumors with SBRT and reports on dosimetric correlates of outcome. METHODS Between 2009 and 2018, a total of 78 consecutive patients with 81 apical lung tumors underwent SBRT for T1-3N0 non-small cell lung cancer. Apical tumors were those with tumor epicenter superior to the aortic arch. The brachial plexus (BP) was anatomically contoured according to the Radiation Therapy Oncology Group (RTOG) atlas. Patient medical records were retrospectively reviewed to determine incidence of brachial plexus injury (BPI) and a normal tissue complication probability model (NTCP) was applied to the dosimetric data. RESULTS Five patients (6.4%) reported neuropathic symptoms consistent with BPI and occurred a median 11.9 months after treatment (range, 5.2 to 28.1 months). Most common dose and fractionation in those developing BPI were 50 Gy in 5 fractions (4 patients). Symptoms consisted of pain in 2 patients (40.0%), numbness in the hand or axilla in 4 patients (80.0%), and ipsilateral hand weakness in 1 patient (20.0%). In the overall cohort the median BP Dmax (EQD23 Gy) was 5.13 Gy (range, 0.18 to 217.2 Gy) and in patients with BPI the median BP Dmax (EQD23 Gy) was 32.14 Gy (range, 13.4 to 99.9 Gy). The NTCP model gave good fit with an area under the curve (AUC) of 0.75 (OR 7.3, 95% CI: 0.8-68.3) for BP Dmax (EQD23 Gy) threshold of 20 Gy. CONCLUSION Significant variation exists in the dose delivered to the brachial plexus for patients treated by SBRT for apical lung tumors. The incidence of neuropathic symptoms in the post-SBRT setting was appreciable and prospective clinical correlation with dosimetric information should be utilized in order to develop evidence-based dose constraints.
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Affiliation(s)
- Ryan T Morse
- Department of Radiation Oncology, University of Kansas Medical Center
| | - Kaleigh Doke
- Department of Radiation Oncology, University of Colorado
| | - Rohit G Ganju
- Department of Radiation Oncology, University of Kansas Medical Center
| | - Sumit Sood
- Department of Radiation Oncology, University of Minnesota
| | | | - Allen M Chen
- Department of Radiation Oncology, University of California Irvine.
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5
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Attard KA, Vella JC, Chircop C. Late-onset radiation-induced brachial plexopathy. BMJ Case Rep 2021; 14:e243354. [PMID: 34518178 PMCID: PMC8438927 DOI: 10.1136/bcr-2021-243354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/03/2022] Open
Abstract
The late-onset variant of radiation-induced brachial plexopathy is most often seen after treatment for breast or lung cancers. It has an insidious onset, with symptoms noted years after receiving radiotherapy, and the condition gradually continues to deteriorate with time. We present the case of an elderly man who we saw in view of worsening paraesthesias and weakness of his left arm with associated prominent muscle wasting along the left shoulder girdle. Fifteen years prior to this, he had received radiotherapy for the treatment of nasopharyngeal carcinoma.
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Affiliation(s)
| | - James Carlos Vella
- Department of Neurology, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Charmaine Chircop
- Department of Neurology, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Zhao KL, Liu Y, Scherpelz KP, Kao DS, Friedrich JB. Occult primary breast cancer presenting with brachial plexopathy: A case report. SAGE Open Med Case Rep 2021; 9:2050313X20985646. [PMID: 34262768 PMCID: PMC8243102 DOI: 10.1177/2050313x20985646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Breast cancer affects about one in eight women over the course of her lifetime. Occult breast cancer, in which primary breast cancer is detected without evidence of disease in the breast itself, comprises up to 1% of new diagnoses; this is typically detected from abnormal axillary lymph nodes, and distant metastases are rare. Here, we present an unusual case of occult breast cancer presenting as upper extremity pain, edema, and weakness, with a metastatic mass to the brachial plexus being the only site of disease.
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Affiliation(s)
- Karen L Zhao
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Yusha Liu
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Kathryn P Scherpelz
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Dennis S Kao
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Jeffrey B Friedrich
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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7
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Wilcox M, Brown H, Johnson K, Sinisi M, Quick TJ. An assessment of fatigability following nerve transfer to reinnervate elbow flexor muscles. Bone Joint J 2019; 101-B:867-871. [PMID: 31256676 DOI: 10.1302/0301-620x.101b7.bjj-2019-0005.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Improvements in the evaluation of outcomes following peripheral nerve injury are needed. Recent studies have identified muscle fatigue as an inevitable consequence of muscle reinnervation. This study aimed to quantify and characterize muscle fatigue within a standardized surgical model of muscle reinnervation. PATIENTS AND METHODS This retrospective cohort study included 12 patients who underwent Oberlin nerve transfer in an attempt to restore flexion of the elbow following brachial plexus injury. There were ten men and two women with a mean age of 45.5 years (27 to 69). The mean follow-up was 58 months (28 to 100). Repeated and sustained isometric contractions of the elbow flexors were used to assess fatigability of reinnervated muscle. The strength of elbow flexion was measured using a static dynamometer (KgF) and surface electromyography (sEMG). Recordings were used to quantify and characterize fatigability of the reinnervated elbow flexor muscles compared with the uninjured contralateral side. RESULTS The mean peak force of elbow flexion was 7.88 KgF (sd 3.80) compared with 20.65 KgF (sd 6.88) on the contralateral side (p < 0.001). Reinnervated elbow flexor muscles (biceps brachialis) showed sEMG evidence of fatigue earlier than normal controls with sustained (60-second) isometric contraction. Reinnervated elbow flexor muscles also showed a trend towards a faster twitch muscle fibre type. CONCLUSION The assessment of motor outcomes must involve more than peak force alone. Reinnervated muscle shows a shift towards fast twitch fibres following reinnervation with an earlier onset of fatigue. Our findings suggest that fatigue is a clinically relevant characteristic of reinnervated muscle. Adoption of these metrics into clinical practice and the assessment of outcome could allow a more meaningful comparison to be made between differing forms of treatment and encourage advances in the management of motor recovery following nerve transfer. Cite this article: Bone Joint J 2019;101-B:867-871.
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Affiliation(s)
- M Wilcox
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK.,University College London Centre for Nerve Engineering, London, UK
| | - H Brown
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK.,University College London Centre for Nerve Engineering, London, UK
| | - K Johnson
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - M Sinisi
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - T J Quick
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK.,University College London Centre for Nerve Engineering, London, UK
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8
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Chang EI, Rose MI, Rossi K, Elkwood AI. Microneurosurgical treatment options in peripheral nerve compression syndromes after chemotherapy and radiation treatment. J Surg Oncol 2018; 118:793-799. [PMID: 30261113 DOI: 10.1002/jso.25254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 09/05/2018] [Indexed: 12/25/2022]
Abstract
Chemotherapy-induced peripheral neuropathy and radiation-induced brachial plexopathy are extremely debilitating conditions which can occur after treatment of malignancy. Unfortunately, the diagnosis can be elusive, and this dilemma is further compounded by the lack of efficacious therapeutics to prevent the onset of neurotoxicity before initiating chemotherapy or radiation or to treat these sequelae after treatment. However, microsurgical nerve decompression can provide these patients with a viable option to treat this complication.
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Affiliation(s)
- Eric I Chang
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, New Jersey.,Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Michael I Rose
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, New Jersey.,Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Kristie Rossi
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, New Jersey.,Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Andrew I Elkwood
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, New Jersey.,Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
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9
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Abstract
The purpose of this article is to provide an overview of the various nerve transfer options for restoration of elbow function. This article describes nerve transfer strategies for elbow flexion and extension including the indications, limitations, and expected outcomes based on current literature.
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Affiliation(s)
- Liselotte F Bulstra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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10
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Free functioning muscle transfer in radiation-induced brachial plexopathy: case report. J Hand Surg Am 2014; 39:1967-70. [PMID: 25155695 DOI: 10.1016/j.jhsa.2014.06.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 02/02/2023]
Abstract
Radiation-induced brachial plexopathy is a delayed complication of radiation treatment for tumors involving the neck and chest area and is progressive. A 56-year-old woman presented to us with loss of elbow flexion and weak wrist and finger extension 15 years after she received external beam radiation to the left chest, axilla, and supraclavicular region for treatment of breast cancer. She was managed with a gracilis free muscle transfer for elbow flexion and hand prehension. By 2 years after surgery she regained elbow range of motion of 40° to 110° and improved in hand function. She was able to perform activities of daily living. Disabilities of the Arm, Shoulder, and Hand score improved from 56 to 20.
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11
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Gu B, Yang Z, Huang S, Xiao S, Zhang B, Yang L, Zhao J, Zhao Z, Shen J, Liu J. Radiation-induced Brachial Plexus Injury After Radiotherapy for Nasopharyngeal Carcinoma. Jpn J Clin Oncol 2014; 44:736-742. [DOI: 10.1093/jjco/hyu062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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13
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Abstract
Radiotherapy forms an integral part in cancer treatment today. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to effect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment results in fibrosis, nonhealing ulcers, lymphoedema and radionecrosis amongst others. This article will discuss the pathophysiology in brief, along with the manifestations of radiation-induced injury and the treatment available currently.
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Affiliation(s)
- Subramania Iyer
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India ; Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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14
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Abstract
In the past decade, more than 100 different composite tissue allotransplantation (CTA) procedures have been performed around the world including more than 50 hand and 8 facial transplants with encouraging graft survival and excellent functional outcomes. Broader clinical application of CTA, however, continues to be hampered by requirement for long-term, high-dose, multidrug maintenance immunosuppression to prevent graft rejection mediated particularly by composite tissue allograft's highly immunogenic skin component. Medication toxicity could result in severe adverse events including metabolic and infectious complications or malignancy. Notably, unlike in solid organs, clinical success is dictated not only by graft acceptance and survival but also by nerve regeneration, which determines ultimate functional outcomes. Novel strategies such as cellular and biologic therapies that integrate the concepts of immune regulation with those of nerve regeneration have shown promising results in small and large animal models. Clinical translation of these insights to reconstructive transplantation and CTA could further minimize the need of immunosuppression and optimize functional outcomes. This will enable wider application of such treatment options for patients in need of complex reconstructive surgery for congenital deformities or devastating injuries that are not amenable to standard methods of repair.
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Affiliation(s)
- Gerald Brandacher
- Divison of Plastic and Reconstructive Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Ray WZ, Kasukurthi R, Yee A, Mackinnon SE. Functional recovery following an end to side neurorrhaphy of the accessory nerve to the suprascapular nerve: case report. Hand (N Y) 2010; 5:313-7. [PMID: 19902308 PMCID: PMC2920384 DOI: 10.1007/s11552-009-9242-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 10/19/2009] [Indexed: 12/18/2022]
Abstract
UNLABELLED The use of end-to-side neurrorhaphy remains a controversial topic in peripheral nerve surgery. The authors report the long-term functional outcome following a modified end-to-side motor reinnervation using the spinal accessory to innervate the suprascapular nerve following a C5 to C6 avulsion injury. Additionally, functional outcomes of an end-to-end neurotization of the triceps branch to the axillary nerve and double fascicular transfer of the ulnar and medial nerve to the biceps and brachialis are presented. Excellent functional recoveries are found in respect to shoulder abduction and flexion and elbow flexion. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (doi:10.1007/s11552-009-9242-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Rahul Kasukurthi
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110 USA
| | - Andrew Yee
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO USA ,Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110 USA
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110 USA
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Tung TH, Mackinnon SE. Nerve transfers: indications, techniques, and outcomes. J Hand Surg Am 2010; 35:332-41. [PMID: 20141906 DOI: 10.1016/j.jhsa.2009.12.002] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/02/2009] [Indexed: 02/02/2023]
Abstract
This article provides an update of the current strategies of motor and sensory nerve transfers for peripheral nerve lesions of the upper extremity. Indications, techniques, and outcomes are summarized for both well-established transfers used in the management of proximal and brachial plexus injuries as well as those more recently developed for more distal and isolated nerve injuries in the forearm and hand.
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Affiliation(s)
- Thomas H Tung
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
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17
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Moore AM, Ray WZ, Chenard KE, Tung T, Mackinnon SE. Nerve allotransplantation as it pertains to composite tissue transplantation. Hand (N Y) 2009; 4:239-44. [PMID: 19306048 PMCID: PMC2724627 DOI: 10.1007/s11552-009-9183-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 11/06/2008] [Indexed: 12/29/2022]
Abstract
Nerve allografts provide a temporary scaffold for host nerve regeneration and allow for the repair of significant segmental nerve injuries. From rodent, large animal, and nonhuman primate studies, as well as clinical experience, nerve allografts, with the use of immunosuppression, have the capacity to provide equal regeneration and function to that of an autograft. In contrast to solid organ transplantation and composite tissue transfers, nerve allograft transplantation requires only temporary immunosuppression. Furthermore, nerve allograft rejection is difficult to assess, as the nerves are surgically buried and are without an immediate functional endpoint to monitor. In this article, we review what we know about peripheral nerve allograft transplantation from three decades of experience and apply our current understanding of nerve regeneration to the emerging field of composite tissue transplantation.
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Affiliation(s)
- Amy M. Moore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 S. Euclid Avenue, St. Louis, MO 63110 USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63116 USA
| | - Kristofer E. Chenard
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 S. Euclid Avenue, St. Louis, MO 63110 USA
| | - Thomas Tung
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 S. Euclid Avenue, St. Louis, MO 63110 USA
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 S. Euclid Avenue, St. Louis, MO 63110 USA
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