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Abboud J, Sader Z, Flouzat-Lachaniette CH, Dubory A, Moussa MK, Facca S, Zeaiter N, Souleiman B, Jaber MH, Tannous A, Dagher T, Ghandour M. The comparative efficacy of nerve transfer versus tendon transfer in the management of radial palsy: A systematic review and meta-analysis. J Orthop 2024; 48:25-31. [PMID: 38059217 PMCID: PMC10696201 DOI: 10.1016/j.jor.2023.11.026] [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: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
Background There is no clear census as to which operative technique provides better recovery for radial nerve injuries. Therefore, in this systematic review, we examined the functional recovery, patient-reported outcomes, and complications of tendon transfer (TT) and nerve transfer (NT). Methods Five electronic databases were searched for studies (>10 cases per study) comparing NT and TT regardless of the study design (observational or experimental). Manual search was also conducted. The quality was assessed by the NIH tool. Outcomes included functional recovery, patient-reported outcomes (DASH score, satisfaction, and inability to return to work), and complications. The prevalence was pooled across studies using STATA software, and then, a subgroup analysis based on the intervention type. Results Twenty-one studies (542 patients) were analyzed. Excellent recovery, assessed by the Bincaz scale, was higher in the TT group (29 % vs. 11 %) as well as failure to extend the fingers (49 % vs. 9 %). No significant difference was noted between both groups regarding DASH score (mean difference = -2.76; 95 % CI: -12.66: 6.93). Satisfaction was great in the TT group (89 %) with a limited proportion of patients unable to return to work (7 %). Complications were slightly higher in the TT group (8 % vs. 7 %) while 18 % of patients undergoing TT requiring revision surgery. Radial deviation was encountered in 18 % of patients in the TT group and 0 % in the NT group. The quality was good, fair, and poor in 2, 13, and 6, respectively. Conclusions In radial nerve injuries, although tendon transfer may seem to provide better functional motor recovery than nerve transfer, it is associated with a higher rate of failure to extend the finger. Given the large confidence interval, the accuracy of this finding is questioned. However, a great proportion of those patients require revision surgery afterward. Additionally, tendon transfer is associated with a greater complication rate than nerve transfer, particularly radial deviation.
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Affiliation(s)
- Johnny Abboud
- CHU Henri Mondor, Université Paris Est, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Ziad Sader
- Service d’Orthopédie et Traumatologie, Hôpitaux Civils de Colmar, France
| | | | - Arnaud Dubory
- CHU Henri Mondor, Université Paris Est, 1 rue Gustave Eiffel, 94000, Créteil, France
| | | | - Sybille Facca
- Orthopedic and Hand Surgery Dept, SOS Hand Group Practice, Strasbourg University Hospitals, 10, avenue Achille-Baumann, 67403, Illkirch cedex, France
| | - Nancy Zeaiter
- Plastic Surgery Department, Lebanese University, Beirut, Lebanon
| | | | | | | | - Tanios Dagher
- Orthopedic Department, Lebanese University, Beirut, Lebanon
| | - Maher Ghandour
- Orthopedic Department, Lebanese University, Beirut, Lebanon
- Orthopedic Department, Heidelberg University Hospital, Germany
- Department of Orthopedics Surgery, CHU Grenoble Alpes, 38000, Grenoble, France
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Kim SJ, Bang JH, Yang HJ, Moon SH, Choi YR, Lee HY. Anatomical considerations for nerve transfer in axillary nerve injury. Sci Rep 2024; 14:1262. [PMID: 38218996 PMCID: PMC10787799 DOI: 10.1038/s41598-024-51923-w] [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] [Received: 08/04/2023] [Accepted: 01/11/2024] [Indexed: 01/15/2024] Open
Abstract
This study investigated the anatomical details of the axillary and radial nerves in 50 upper limbs from 29 adult formalin-embalmed cadavers, and ten fresh upper limbs. The focus was on understanding the course, division, and ramifications of these nerves to improve treatment of shoulder dysfunction caused by axillary nerve damage. The axillary nerve divided anteriorly and posteriorly before passing the quadrangular space in all specimens, with specific distances to the first ramifications. It was found that the deltoid muscle's clavicular and acromial parts were always innervated by the anterior division of the axillary nerve, whereas the spinous part was variably innervated. The longest and thickest branches of the radial nerve to the triceps muscles were identified, with no statistically significant differences in fiber numbers among triceps branches. The study concludes that nerve transfer to the anterior division of the axillary nerve can restore the deltoid muscle in about 86% of shoulders, and the teres minor muscle can be restored by nerve transfer to the posterior division. The medial head branch and long head branch of radial nerve were identified as the best donor options.
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Affiliation(s)
- Soo-Jung Kim
- Department of Anatomy, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Medicine, The Graduate School Yonsei University, Seoul, Republic of Korea
| | - Jong-Ho Bang
- Surgical Anatomy Education Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee-Jun Yang
- Department of Anatomy, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- The Youth Clinic, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye-Yeon Lee
- Department of Anatomy, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Beytell L, Mennen E, van Schoor AN, Keough N. The surgical anatomy of the axillary approach for nerve transfer procedures targeting the axillary nerve. Surg Radiol Anat 2023:10.1007/s00276-023-03168-x. [PMID: 37212871 PMCID: PMC10317888 DOI: 10.1007/s00276-023-03168-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE The exact relational anatomy for the anterior axillary approach, targeting the axillary nerve for nerve transfers/grafts, has not been fully investigated. Therefore, this study aimed to dissect and document the gross anatomy surrounding this approach, specifically regarding the axillary nerve and its branches. METHODS Fifty-one formalin-fixed cadavers (98 axilla) were bilaterally dissected simulating the axillary approach. Measurements were taken to quantify distances between identifiable anatomical landmarks and relevant neurovascular structures encountered during this approach. The musculo-arterial triangle, described by Bertelli et al., to aid in identification on localization of the axillary nerve, was also assessed. RESULTS From the origin of the axillary nerve till (1) latissimus dorsi was 62.3 ± 10.7 mm and till (2) its division into anterior and posterior branches was 38.8 ± 9.6 mm. The origin of the teres minor branch along the posterior division of the axillary nerve was recorded as 6.4 ± 2.9 mm in females and 7.4 ± 2.8 mm in males. The musculo-arterial triangle reliably identified the axillary nerve in only 60.2% of the sample. CONCLUSION The results clearly demonstrate that the axillary nerve and its divisions can be easily identified with this approach. The proximal axillary nerve, however, was situated deep and therefore challenging to expose. The musculo-arterial triangle was relatively successful in localising the axillary nerve, however, more consistent landmarks such as the latissimus dorsi, subscapularis, and quadrangular space have been suggested. The axillary approach may serve as a reliable and safe method to reach the axillary nerve and its divisions, allowing for adequate exposure when considering a nerve transfer or graft.
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Affiliation(s)
- Levo Beytell
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Erich Mennen
- Orthopaedic Surgeon, Mediclinic Kloof Hospital, Pretoria, South Africa
| | - Albert-Neels van Schoor
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Natalie Keough
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
- Clinical Anatomy and Imaging, Department of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
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Fairley JA, Daneshvar P. AIN to PIN transfer for PIN palsy following distal biceps tendon repair: a case report. Case Reports Plast Surg Hand Surg 2022; 9:173-178. [PMID: 35873924 PMCID: PMC9302018 DOI: 10.1080/23320885.2022.2096614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Posterior interosseous nerve injury after distal biceps repair significantly impairs hand function. For treatment, we describe an anterior interosseous nerve to posterior interosseous nerve transfer. Our technique is useful when the injury is too distal for median nerve transfer or when the zone of injury is too long for nerve graft reconstruction.
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Affiliation(s)
- Jillian A. Fairley
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parham Daneshvar
- Department of Orthopaedic Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
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Garg V, Regmi A, Negi NK, Yasam R, Sinha SK, Singh V. Distal Nerve Transfer to Restore Wrist and Finger Extension - A Systematic Review. J Hand Surg Asian Pac Vol 2022; 27:1000-1007. [PMID: 36550081 DOI: 10.1142/s2424835522500953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review of the effectiveness of nerve transfer for radial nerve palsy. Methods: Electronic literature research of PubMed, Cochrane, Scopus and Lilacs database was conducted in June 2021 using the terms 'Distal nerve transfer' AND 'Radial nerve injury' 'Radial nerve palsy' OR 'Radial nerve paresis' OR 'Median nerve transfer' OR 'wrist extensor' OR 'finger extension' OR 'thumb extension' OR 'wrist motion'. The data extracted included the study details, demographic data, procedure performed and final functional outcome according to the muscle research council scale. Results: A total of 92.59% and 56.52% had satisfactory outcome following distal nerve transfer of median nerve to restore wrist and finger extension respectively. No significant correlation was found between time to injury duration and satisfactory outcomes. Conclusions: Outcomes of nerve transfers are comparable to tendon transfers. Multi-centric studies are needed to compare the results amongst various surgical procedures described. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Varun Garg
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | - Anil Regmi
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | | | - Ramapriya Yasam
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | | | - Vivek Singh
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
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Keidan T, Greenberg A, Mudalige B, Klein N, Oron A. The Gantzer transfer - Assessment of the feasibility of using the nerve supplying the Gantzer muscle for end-to-side supercharging of the ulnar nerve. HAND SURGERY & REHABILITATION 2022; 41:477-480. [PMID: 35476954 DOI: 10.1016/j.hansur.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 11/27/2022]
Abstract
Our study aimed at assessing the anatomical feasibility of using the nerve supplying the Gantzer muscle (GM) to supercharge the ulnar nerve following injury. The GM nerve was dissected and measured in 36 forearms. The distance between its origin and the lateral epicondyle of humerus and between the GM nerve and the ulnar nerve was measured. The GM was present in 15 forearms (47%). The average distance between the origin of the GM nerve and the lateral epicondyle was 7.34 cm (range 3.3-9.1 cm). The average length of the GM nerve was 3.05 cm (range 1.6-4.5 cm) from origin to neuromuscular junction. The average distance from the ulnar nerve was 2.56 cm (range 1.8-13 3.4 cm). The length of the GM nerve was significantly greater (p < 0.05) than the perpendicular distance between its origin and the ulnar nerve, allowing ample margin for side-to-side or end-to-side supercharging of the ulnar nerve with minimal or no need for further translocation or dissection. The use of the GM nerve as donor following ulnar nerve injury may provide an alternative to the pronator quadratus nerve for supercharged end-to-side transfer, or as an addition, thus supercharging the ulnar nerve twice.
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Affiliation(s)
- T Keidan
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel.
| | - A Greenberg
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel
| | - B Mudalige
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel
| | - N Klein
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel
| | - A Oron
- Kaplan Medical Center, Derech Pasternak 1, Rehovot, Israel
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Hara T, Tatebe M, Kurahashi T, Hirata H. Iatrogenic peripheral nerve injuries - Common causes and treatment: A retrospective single-center cohort study. J Orthop Sci 2021; 26:1119-1123. [PMID: 33115634 DOI: 10.1016/j.jos.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Iatrogenic nerve injuries can result from surgical damage. Thus, physicians should be aware of the risk factors and procedures that need to be followed in such patients. The purpose of this study was to examine data pertaining to patients with known iatrogenic nerve injuries and to elucidate the detailed causes of these injuries, the affected nerves, and the type of surgical procedures for treatment. METHODS This retrospective study included 232 consecutive patients who underwent surgical treatment for peripheral nerve palsy or nerve injury between 2006 and 2017 at our hospital. Among the 232 patients investigated, we identified 51 cases with iatrogenic nerve injuries (23 women and 28 men; mean age, 51.3 years). Among the 51 patients, 45 were referred from other hospitals, and the remaining were from our hospital. Data were summarized using descriptive statistics. RESULTS Direct surgical damage occurred in 94% (48/51) of patients with iatrogenic nerve injuries. Such injuries mostly developed after surgery for bone fractures (33%), resection of soft tissue tumors (22%), and carpal tunnel release procedures (20%). The nerves most commonly affected in such procedures are the radial nerve (26%), median nerve (24%), and ulnar nerve (17%). The median interval of referral to our hospital after nerve injury was 5.1 months. The median interval of surgery to correct the injury was 7 months. Surgeries to correct iatrogenic nerve injuries performed at our hospital included neurolysis (55%), nerve grafts (29%), direct suture procedures (10%), and tendon transfers (6%). CONCLUSIONS We believe that wide dissemination of the results obtained in this study will reduce the incidence of iatrogenic peripheral nerve injuries and increase the speed of referrals to specialized centers.
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Affiliation(s)
- Tatsuya Hara
- Department of Orthopaedic Surgery, Anjo Kosei Hospital, Japan.
| | - Masahiro Tatebe
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
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Castanov V, Berger MJ, Ritsma B, Trier J, Hendry JM. Optimizing the timing of peripheral nerve transfers for functional re-animation in cervical spinal cord injury: a conceptual framework. J Neurotrauma 2021; 38:3365-3375. [PMID: 34715742 DOI: 10.1089/neu.2021.0247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Loss of upper extremity function following spinal cord injury (SCI) can have devastating consequences on quality of life. Peripheral nerve transfer surgery aims to restore motor control of upper extremities following cervical SCI and is poised to revolutionize surgical management in this population. The surgery involves dividing an expendable donor nerve above the level of the spinal lesion and coapting it to a recipient nerve arising from the lesional or infralesional segment of the injured cord. In order to maximize outcomes in this complex patient population, refinements in surgical technique need to be integrated with principles of spinal cord medicine and basic science. Deciding on the ideal timing of nerve transfer surgery is one aspect of care that is critical to maximizing recovery and has received very little attention to date in the literature. This complex topic is reviewed, with a focus on expectations for spontaneous recovery within upper motor neuron components of the injury, balanced against the need for expeditious reinnervation for lower motor neuron elements of the injury. The discussion also considers the case of a patient with C6 motor complete SCI where myotomes without electrodiagnostic evidence of denervation spontaneously improved by 6 months post-injury, thereby adjusting the surgical plan. The relevant concepts are integrated into a clinical algorithm with recommendations that consider maximal opportunity for spontaneous clinical improvement post-injury while avoiding excessive delays that may adversely affect patient outcomes.
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Affiliation(s)
- Valera Castanov
- Queen's University, 4257, School of Medicine, Kingston, Ontario, Canada;
| | - Michael James Berger
- The University of British Columbia, 8166, Division of Physical Medicine and Rehabilitation, Vancouver, British Columbia, Canada.,The University of British Columbia, 8166, International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada;
| | - Benjamin Ritsma
- Queen's University, 4257, Department of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada.,Providence Care Hospital, 4256, Kingston, Ontario, Canada;
| | - Jessica Trier
- Queen's University, 4257, Department of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada.,Providence Care Hospital, 4256, Kingston, Ontario, Canada;
| | - J Michael Hendry
- Queen's University, 4257, School of Medicine, Kingston, Ontario, Canada.,Queen's University, 4257, Division of Plastic Surgery, Department of Surgery, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, 71459, Kingston, Ontario, Canada;
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Coulet B, Chammas M. Palsy of elbow extension. HAND SURGERY & REHABILITATION 2021; 41S:S83-S89. [PMID: 34428569 DOI: 10.1016/j.hansur.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 10/20/2022]
Abstract
Elbow extension palsy is generally well tolerated, because when standing up, it is alleviated by gravity. In the case of trunk paralysis or brachial plexus palsy, standing is possible, thus the restoration of active elbow extension improves the hand's positioning above the shoulder, and allows the elbow to be locked in extension, which is necessary during certain activities such as cycling. In these palsy cases, the triceps brachii will be reinnervated by nerve transfers if surgery is performed early enough before irreversible atrophy of the effector muscle sets in. In these situations, secondary tendon transfers are rarely indicated. Few available muscles can be harvested without deleterious consequences on the donor site. Finally, in patients with a very deficient upper limb but with a healthy contralateral limb, when nerve transfers are no longer possible, elbow extension will not be restored. In the tetraplegics using a wheelchair, elbow extension becomes essential for positioning the hand in space and for potentiating the transferable muscles to activate the hand. As nerve transfers have rare indications and are currently being validated in this population, palliative tendon transfers are the reference technique. They must be integrated into an overall upper limb reconstructive surgery program that takes into consideration the potentially usable muscles and the presence of elbow flexion contracture and supination deformity of the forearm. Elbow extension restoration techniques are based on the transfer of two muscles, the posterior deltoid and the biceps brachii. The first is very effective and has very specific requirements, notably good anterior stabilization of the shoulder by the pectoralis major, while the second has broader indications, notably in the case of elbow contracture and inability to stabilize the shoulder anteriorly.
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Affiliation(s)
- B Coulet
- Faculté de Médecine, Université Montpellier 1, 5, Boulevard Henri IV, 34090 Montpellier, France; Service de chirurgie de la main et du membre supérieur, chirurgie des paralysies, Institut de Neuro-Orthopédie Montpellier, Hôpital Lapeyronie, CHU de Montpellier, Avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
| | - M Chammas
- Faculté de Médecine, Université Montpellier 1, 5, Boulevard Henri IV, 34090 Montpellier, France; Service de chirurgie de la main et du membre supérieur, chirurgie des paralysies, Institut de Neuro-Orthopédie Montpellier, Hôpital Lapeyronie, CHU de Montpellier, Avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
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10
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Nerve transfer in the spastic upper limb: anatomical feasibility study. Surg Radiol Anat 2021; 44:183-190. [PMID: 34406434 DOI: 10.1007/s00276-021-02810-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Nerve transfers represent an innovative tool in the surgical treatment of upper limb paralysis. Well-documented for brachial plexus sequalae and under evaluation for tetraplegic patients, they have not yet been described for spastic upper limbs. The typical spastic deformity involves active and spastic flexor, adductor and pronator muscles, associated with paralysed extensor and supinator muscles. Experience with selective neurectomy has shown an effective decrease in spasticity together with preservation of muscle strength. We conceptualized a combination of neurectomy and nerve transfer, by performing a partial nerve transfer from a spastic elbow flexor muscle to a paralyzed wrist extensor muscle, hypothesizing that this would reduce the spasticity of the former and simultaneously activate the latter. METHODS Ten cadaveric dissections were performed in order to establish the anatomic feasibility of transferring a motor branch of the brachioradialis (BR) onto the branch of the extensor carpi radialis longus (ECRL) or brevis (ECRB). We measured the emergence, length, muscle entry point and diameter of each branch, and attempted the transfer. RESULTS We found 1-4 motor nerve for the BR muscle and 1-2 for the ECRL muscle. In all cases, the nerve transfer was achievable, allowing a satisfactory coaptation. The ECRB branch emerged too distally to be anastomosed to one of the BR branches. CONCLUSION This study shows that nerve transfers from the BR to the ECRL are anatomically feasible. It may open the way to an additional therapeutic approach for spastic upper limbs.
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Tordjman D, d'Utruy A, Bauer B, Bellemère P, Pierrart J, Masmejean E. Tendon transfer surgery for radial nerve palsy. HAND SURGERY & REHABILITATION 2021; 41S:S90-S97. [PMID: 34343724 DOI: 10.1016/j.hansur.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/11/2018] [Accepted: 09/11/2018] [Indexed: 10/20/2022]
Abstract
Palliative tendon transfer is an integral part of radial nerve palsy treatment. It can be considered in the first weeks when the possibility of nerve repair by direct suture or nerve grafting is not feasible or reasonable. Mostly, it is discussed secondarily when it is too late for nerve surgery and motor recovery cannot be expected, or after failure or incomplete recovery after nerve repair. The goal of tendon transfers is to restore wrist, finger and thumb extension. For wrist extension, the use of pronator teres is well accepted. The best tendon transfer for finger extension is debated. This can be restored doing a flexor carpi ulnaris (FCU), flexor carpi radialis or flexor digitorum superficialis (FDS) to extensor digitorum communis transfer. Regarding thumb extension and abduction, a palmaris longus (PL) or one FDS tendon to the rerouted extensor pollicis longus (EPL) transfer can be performed. If a transfer is done on the EPL without rerouting it, abduction can be restored by doing a tendon transfer to the abductor pollicis longus (APL) or an APL tenodesis. The different tendon transfer options are selected based on the surgeon's preference, and most importantly, discussed with the patients to define the objectives together. The transfer is chosen based on the clinical examination (high or low radial nerve palsy, tendon available for transfer like PL, wrist mobility) and based on the patient's needs and expectations (activities requiring the FCU, finger independence, independence of thumb extension or abduction). If the surgical rules and the postoperative instructions for rehabilitation are followed, tendon transfers for radial nerve palsy regularly produce very satisfactory results.
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Affiliation(s)
- D Tordjman
- Hand Surgery Unit, Orthopedic Division, Tel Aviv Sourasky Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel.
| | - A d'Utruy
- Hôpital Privé de Versailles, 7 bis A, rue de la Porte de Buc, 78000 Versailles, France
| | - B Bauer
- Hôpital Privé d'Antony, 1, rue Velpeau, 92160 Antony, France
| | - P Bellemère
- Institut de la main Nantes-Atlantique, Santé Atlantique, boulevard Charles Gauthier, 44800 Saint-Herblain, France
| | - J Pierrart
- Cabinet Archimed, Clinique des 2 Caps, 80 avenue des Longues Pièces, 62231 Coquelles, France
| | - E Masmejean
- University of Paris, 15, rue de l'Ecole de Médecine, 75006 Paris, France; Hand, Upper Limb & Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), 20, rue Leblanc, 75015 Paris, France; Research Unit - Clinique Blomet, 136 bis, rue Blomet 75015 Paris, France
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Cambon-Binder A, Chammas M, Coulet B, Lazerges C, Thaury MN. Tendon transfers to restore elbow flexion. HAND SURGERY & REHABILITATION 2021; 41S:S76-S82. [PMID: 34146744 DOI: 10.1016/j.hansur.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 03/26/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Abstract
Elbow flexion paralysis is one of most significant deficiencies in the upper limb. When secondary to brachial plexus palsy or nerve trunk lesions, restoration of elbow flexion by means of early nerve surgery or palliative transfers should be part of a comprehensive treatment plan. Tendon transfers are indicated in long-standing palsies, in those who are poor candidates for nerve surgery or when the results of nerve surgery are inadequate. A regional pedicled muscle transfer is performed if available. In this case, a "strong" donor is preferred (pectoralis major with pectoralis minor transfer, triceps brachii to biceps brachii transfer, or bipolar latissimus dorsi transfer). A "weak" transfer is indicated in patients who have incomplete recovery of elbow flexion (MRC 2 strength): isolated pectoralis minor transfer, medial epicondylar muscle transfer according to Steindler technique, or advancement of biceps brachii tendon on forearm. When no donor muscle is available, a free reinnervated muscle transfer may be indicated if age and nerve regeneration conditions are favorable.
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Affiliation(s)
- A Cambon-Binder
- Service d'orthopédie et de chirurgie du membre supérieur, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - M Chammas
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, Hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
| | - B Coulet
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, Hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France
| | - C Lazerges
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, Hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France
| | - M-N Thaury
- Clinique de rééducation et de réadaptation fonctionnelle du Dr Ster. 9, avenue du Dr Jean Ster, 34240 Lamalou-les-Bains, France
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Moucharafieh RC, Badra MI, Boulos KA, Mansour JI, Daher JC, Wardani HM, Nour HGAE, Sayde EG, Nehme AH. Nerve transfers in the upper extremity: A review. Injury 2020; 51:2804-2810. [PMID: 32448466 DOI: 10.1016/j.injury.2020.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023]
Abstract
Injury of the brachial plexus and peripheral nerve often result in significant upper extremity dysfunction and disability. Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries. These transfers require an intimate knowledge of nerve topography, a technically demanding Intraneural dissection and require extensive physical therapy for retraining. In this review, we present a summary of the most widely accepted nerve transfers in the upper extremity described in the current literature.
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Affiliation(s)
- Ramzi C Moucharafieh
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon; Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center Affiliated With Johns Hopkins International, Clemenceau Beirut, Lebanon.
| | - Mohammad I Badra
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center Affiliated With Johns Hopkins International, Clemenceau Beirut, Lebanon
| | - Karl A Boulos
- Department of Orthopedic Surgery, Lebanese American University Medical Center Rizk hospital, Achrafieh, Beirut, Lebanon
| | - Jad I Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center Rizk hospital, Achrafieh, Beirut, Lebanon
| | - Jimmy C Daher
- Department of Orthopedic Surgery, Lebanese American University Medical Center Rizk hospital, Achrafieh, Beirut, Lebanon
| | - Hassan M Wardani
- Department of Orthopedic Surgery and Traumatology, Clemenceau Medical Center Affiliated With Johns Hopkins International, Clemenceau Beirut, Lebanon
| | - Hicham G Abd El Nour
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon
| | - Elias G Sayde
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon
| | - Alexandre H Nehme
- Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon
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Heinzel J, Längle G, Oberhauser V, Hausner T, Kolbenschlag J, Prahm C, Grillari J, Hercher D. Use of the CatWalk gait analysis system to assess functional recovery in rodent models of peripheral nerve injury – a systematic review. J Neurosci Methods 2020; 345:108889. [DOI: 10.1016/j.jneumeth.2020.108889] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
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Abstract
The arm is less often concerned by reconstructive surgeries than more distal parts of the upper extremity. However, when affected, the arm is frequently part of complex mutilating injuries involving composite defects. For a given traumatic or oncologic defect, there are several reconstructive options and choosing the right sequence may pose a challenge even to the most experienced surgeon. The latter must integrate not only functional and esthetic requirements, but also the surgeon's habits, especially in situations of emergency. Once life-threatening conditions are averted, wound debridement, bony stabilization, neurovascular, and cutaneous reconstruction tailored to the defects should be performed in a single-stage procedure. Functionally, prompt bony stabilization is necessary to allow early mobilization. Diaphyseal shortening of the humerus can be a salvage procedure to avoid nerve and vascular grafting, with good biomechanical tolerance up to 5cm. Restoration of adequate elbow motion sometimes requires muscle transfer and should be a main concern, as proper positioning of the hand during daily activities demands a functional elbow joint. Esthetically, the surgeon must choose the most cosmetic skin coverage option whilst limiting morbidity of the donor site area. The flaps vascularized by the sub- scapular or thoraco-dorsal vessels are the most useful flaps for arm reconstruction. This paper discusses the reconstructive sequence of complex defects of the arm and provides a review of commonly used reconstructive techniques supported with illustrative cases.
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Molotkovets VY, Medvediev VV, Korsak AV, Chaikovsky YB, Marynsky GS, Tsymbaliuk VI. Restoration of the Integrity of a Transected Peripheral Nerve with the Use of an Electric Welding Technology. NEUROPHYSIOLOGY+ 2020. [DOI: 10.1007/s11062-020-09848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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17
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Extradural Contralateral C7 Nerve Root Transfer in a Cervical Posterior Approach for Treating Spastic Limb Paralysis: A Cadaver Feasibility Study. Spine (Phila Pa 1976) 2020; 45:E608-E615. [PMID: 31770316 DOI: 10.1097/brs.0000000000003349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Anatomic study in nine fresh-frozen cadavers. OBJECTIVE To confirm the anatomical feasibility of transferring the extradural ventral roots (VRs) and dorsal roots (DRs) of contralateral C7 nerves to those of the ipsilateral C7 nerves respectively through a cervical posterior approach. SUMMARY OF BACKGROUND DATA The contralateral C7 nerve root transfer technique makes breakthrough for treating spastic limb paralysis. However, its limitations include large surgical trauma and limited indications. METHODS Nine fresh-frozen cadavers (four females and five males) were placed prone, and the feasibility of exposing the bilateral extradural C7 nerve roots, separation of the extradural C7 VR and DR, and transfer of the VR and DR of the contralateral C7 to those of the ipsilateral C7 on the dural mater were assessed. The pertinent distances and the myelography results of each specimen were analyzed. The acetylcholinesterase (AChE) and antineurofilament 200 (NF200) double immunofluorescent staining were preformed to determine the nerve fiber properties. RESULTS A cervical posterior midline approach was made and the laminectomy was performed to expose the bilateral extradural C7 nerve roots. After the extradural C7 VR and DR are separated, the VR and DR of the contralateral C7 have sufficient lengths to be transferred to those of the ipsilateral C7 on the dural mater. The myelography results showed that the spinal cord is not compressed after the nerve anastomosis. The AChE and NF200 double immunofluorescent staining showed the distal ends of the contralateral C7 VRs were mostly motor nerve fibers, and the distal ends of the contralateral C7 DRs were mostly sensory nerve fibers. CONCLUSION Extradural contralateral C7 nerve root transfer in a cervical posterior approach for treating spastic limb paralysis is anatomically feasible. LEVEL OF EVIDENCE 5.
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Martin E, Dullaart MJ, Verhoef C, Coert JH. A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: A need for general implementation in the armamentarium. J Plast Reconstr Aesthet Surg 2020; 73:621-632. [PMID: 32088187 DOI: 10.1016/j.bjps.2019.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Resection of nerves in extremity soft tissue sarcomas (STS) can lead to large functional deficits. Nerve reconstructions are rarely performed and little is known on their outcomes and indications for their use, even though they are essential in restoring sensation in limb salvage procedures. This study investigated current knowledge on functional outcomes and considerations to be taken before performing such reconstructions after sarcoma resection. A systematic search was performed in July 2018 in PubMed and Embase databases according to PRISMA guidelines. Search terms related to "soft tissue sarcoma" and "nerve reconstruction" were used. Studies evaluating functional outcomes after nerve grafting or nerve transfers in extremity STS were included. Qualitative synthesis was performed on all studies. Nineteen studies were included after full-text screening, describing 26 patients. The majority of patients had a nerve reconstruction in the upper extremity (65%). Perioperative radiotherapy was administered in 67% and perioperative chemotherapy in 29% of patients. Nerve grafting was most commonly performed (n = 23) and nerve transfers were performed in six patients. A wide variety of outcome measures were used. Most patients recovered at least some motor function and sensation, but success rates were higher after upper than lower extremity defects. Multimodal treatment did not preclude successful reconstructions. Nerve reconstructions in extremity STS allow the restoration of sensation in limb salvation, even motor nerve function can be restored with satisfactory function. The use of multimodal therapy does not seem to interfere with success. Nerve reconstructions should therefore be considered in STS patients.
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Affiliation(s)
- Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands.
| | - Max J Dullaart
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Molewaterplein 40, Rotterdam, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands.
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Haninec P, Hradecky J, Mencl L. Lower subscapular nerve transfer for axillary nerve repair in upper brachial plexus palsy. Acta Neurochir (Wien) 2020; 162:135-139. [PMID: 31713155 DOI: 10.1007/s00701-019-04122-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The potential to utilize the lower subscapular nerve for brachial plexus surgery has been suggested in many anatomical studies. However, we know of no studies in the literature describing the use of the lower subscapular nerve for axillary nerve reconstruction to date. This study aimed to examine the effectiveness of this nerve transfer in patients with upper brachial plexus palsy. METHODS Of 1340 nerve reconstructions in 568 patients with brachial plexus injury performed by the senior author (P.H.), a subset of 18 patients underwent axillary nerve reconstruction using the lower subscapular nerve and constitutes the patient group for this study. The median age was 48 years, and the median time between trauma and surgery was 6 months. A concomitant radial nerve injury was found in 8 patients. RESULTS Thirteen patients completed a minimum follow-up period of 24 months. Successful deltoid recovery was defined as (1) muscle strength MRC grade ≥ 3, (2) electromyographic signs of reinnervation, and (3) increase in deltoid muscle mass. Axillary nerve reconstruction was successful in 9 of 13 patients, which represents a success rate of 69.2%. No significant postoperative weakness of shoulder internal rotation or adduction was observed after transecting the lower subscapular nerve. CONCLUSIONS The lower subscapular nerve can be used as a safe and effective neurotization tool for upper brachial plexus injury, having a success rate of 69.2% for axillary nerve repair. Our technique presents a suitable alternative for patients with concomitant radial nerve injury.
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Affiliation(s)
- Pavel Haninec
- Department of Neurosurgery, 3rd Faculty of Medicine, Charles University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic
| | - Jan Hradecky
- Department of Neurosurgery, 3rd Faculty of Medicine, Charles University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic
| | - Libor Mencl
- Department of Neurosurgery, 3rd Faculty of Medicine, Charles University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
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Wilks AW, Ray WZ, Al-Lozi MT, Bucelli RC. Nerve transfer as a novel treatment for West Nile virus-associated acute flaccid paralysis. J Neurol Sci 2019; 407:116502. [PMID: 31669727 DOI: 10.1016/j.jns.2019.116502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/24/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Anson W Wilks
- Department of Neurology, Washington University School of Medicine, United States of America.
| | - Wilson Z Ray
- Department of Neurosurgery, Washington University School of Medicine, United States of America.
| | - Muhammad T Al-Lozi
- Department of Neurology, Washington University School of Medicine, United States of America.
| | - Robert C Bucelli
- Department of Neurology, Washington University School of Medicine, United States of America.
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21
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Geissler J, Stevanovic M. Management of large peripheral nerve defects with autografting. Injury 2019; 50 Suppl 5:S64-S67. [PMID: 31708089 DOI: 10.1016/j.injury.2019.10.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A segmental nerve defect from trauma results in significant loss of function of the extremity, and rarely occurs in isolation. Autografting of the nerve defect is the current gold standard. METHODS A review of the recent literature regarding peripheral nerve defects after trauma treated with autograft. RESULTS Identification of the zone of nerve injury is difficult and appropriate resection is critical for good outcomes. Meaningful recovery is more likely with application of excellent technique. Many of the factors affecting outcomes are not modifiable. CONCLUSION Nerve grafting for segmental nerve injuries continues to be an essential and appropriate treatment.
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Affiliation(s)
- J Geissler
- Department of Orthopaedic Surgery, University of Minnesota, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, United States.
| | - M Stevanovic
- Department of Orthopaedic Surgery, University of Southern California, Keck School of Medicine, 1520 San Pablo St. Suite 2000, Los Angeles, CA 90033, United States.
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Larson EL, Santosa KB, Mackinnon SE, Snyder-Warwick AK. Median to radial nerve transfer after traumatic radial nerve avulsion in a pediatric patient. J Neurosurg Pediatr 2019; 24:209-214. [PMID: 31151095 PMCID: PMC7191611 DOI: 10.3171/2019.3.peds18550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
This case report describes an isolated radial nerve avulsion in a pediatric patient, treated by combination sensory and motor median to radial nerve transfers. After traumatic avulsion of the proximal radial nerve, a 12-year-old male patient underwent end-to-end transfer of median nerve branches to flexor carpi radialis and flexor digitorum superficialis to the posterior interosseous nerve and extensor carpi radialis nerve, respectively. He underwent end-to-side sensory transfer of the superficial radial sensory to the median sensory nerve. Pronator teres to extensor carpi radialis brevis tendon transfer was simultaneously performed to power short-term wrist extension. Within months after surgery, the patient had regained 9-10/10 sensation in the hand and forearm. In the following months and years, he regained dexterity, independent fine-finger and thumb motions, and 4-5/5 strength in all extensors except the abductor pollicis longus muscle. He grew 25 cm without extremity deformity or need for secondary orthopedic procedures. In appropriate adult and pediatric patients with proximal radial nerve injuries, nerve transfers have advantages over tendon transfers, including restored independent fine finger motions, regained sensation, and reinnervation of multiple muscle groups with minimal donor sacrifice.
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Affiliation(s)
- Ellen L. Larson
- Washington University School of Medicine, St. Louis, Missouri
| | - Katherine B. Santosa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Alison K. Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Translocation of the soleus muscular branch of the tibial nerve to repair high common peroneal nerve injury. Acta Neurochir (Wien) 2019; 161:271-277. [PMID: 30617632 DOI: 10.1007/s00701-018-03797-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/31/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study was performed to evaluate the clinical effect of translocating the soleus muscular branch of the tibial nerve to repair the deep peroneal nerve. METHODS Eight patients were treated for high common peroneal nerve injury. The deep peroneal nerve was separated out from the common peroneal nerve if no injury occurred upon opening the epineurium of the common peroneal nerve. The soleus muscular branch of the tibial nerve was then translocated to the deep peroneal nerve. RESULTS The average follow-up duration was 21.75 months. Electromyography revealed newly appearing electric potentials in the tibialis anterior, extensor hallucis longus, and extensor toe longus muscle at 8 to 10 months postoperatively. Four patients showed good functional recovery after surgery; functional recovery was poor in other patients. CONCLUSIONS Translocation of the soleus muscle branch is a feasible method to treat high common peroneal nerve injuries. A full understanding of the indications for this operation is required.
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Laulan J. High radial nerve palsy. HAND SURGERY & REHABILITATION 2018; 38:2-13. [PMID: 30528552 DOI: 10.1016/j.hansur.2018.10.243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/16/2018] [Accepted: 10/02/2018] [Indexed: 12/30/2022]
Abstract
High radial palsy is primarily associated with humeral shaft fractures, whether primary due to the initial trauma, or secondary to their treatment. The majority will spontaneously recover, therefore early surgical exploration is mainly indicated for open fractures or if ultrasonography shows severe nerve damage. Initial signs of nerve recovery may appear between 2 weeks and 6 months. Otherwise, the decision to explore the nerve is based on the patient's age, clinical examination and electroneuromyography, as well as ultrasonography findings. If recovery does not occur, an autograft is indicated only in younger patients, before 6 months, if local conditions are suitable. Otherwise, nerve transfers performed by an experienced team give satisfactory results and can be offered up to 10 months post-injury. Tendon transfers are the gold standard treatment and the only option available beyond 10 to 12 months. The results are reliable and fast.
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Affiliation(s)
- J Laulan
- CHRU de Tours, hôpital Trousseau, services d'orthopédie 1 et 2, unité de chirurgie de la main et du membre supérieur, 37044 Tours cedex 9, France.
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Systematic Review of Tendon Transfer Versus Nerve Transfer for the Restoration of Wrist Extension in Isolated Traumatic Radial Nerve Palsy. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e001. [PMID: 30211383 PMCID: PMC6132323 DOI: 10.5435/jaaosglobal-d-18-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To compare the outcomes of tendon transfer and nerve transfer for radial nerve palsy. Methods: We performed a systematic review of the literature in EMBASE, PubMed, and Cochrane Database to include studies that address persistent traumatic radial nerve palsy treated with tendon transfer or nerve transfer surgery. Results: We identified 2,044 citations; 1,512 texts were excluded because of content, and 96 texts were screened for eligibility. Texts were excluded if they did not report the motor score (M0 to M5 as determined by the British Medical Research Council) or measurements of range of motion of the wrist. Sixteen texts were eligible for qualitative synthesis. Outcomes of these studies show heterogeneity with regard to the technique and functional restoration. Conclusions: On the basis of the results of this systematic review, there does not seem to be a clearly superior technique; rather, there are advantages and disadvantages to each. Patient selection and surgeon experience are important when considering surgical interventions in this challenging clinical scenario. Nerve transfer surgery is an emerging technique that may offer patients meaningful functional gains with reduced donor site morbidity. Level of Evidence: Level III
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