Axillary nerve repair by triceps motor branch transfer through an axillary access: anatomical basis and clinical results

Bertelli, Jayme Augusto; Kechele, Paulo Roberto; Santos, Marcos; Duarte, Hamilton; Ghizoni, Marcos Flávio

doi:10.3171/jns-07/08/0370

Cited by 97 publications

(101 citation statements)

References 29 publications

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“…The findings of some studies challenge the traditional notions of the classic pattern [5,12,14]. Cases of axillary nerve innervation to the long head of the triceps have been documented in cadaveric specimen in several studies [4,5,12]. Our purpose for this study was to provide innervation data for the long head of the triceps regarding additional brachial plexuses and to determine if our sample would result in findings similar to those in the published series.…”

Section: Discussionmentioning

confidence: 58%

“…Additionally, we did not attempt to determine if the nerve bundles had motor, sensory, or mixed functionality. Our specimens may not be representative of all populations as they were from a geographic region distinctly different from those in the prior publishes studies [4,5,12]. The actual ancestry data of the individual cadavers were not available.…”

Section: Discussionmentioning

confidence: 92%

“…Awareness of the possible dual innervation of the long head of the triceps has potential value in the surgical treatment of deltoid dysfunction attributable to axillary nerve injury [4]. In an individual with dual innervation, the axillary branch to the triceps could be rerouted to the deltoid while the radial nerve branch to the triceps could be left intact to maintain triceps function.…”

Section: Discussionmentioning

confidence: 99%

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Variations in the Innervation of the Long Head of the Triceps Brachii: A Cadaveric Investigation

Erhardt

Futterman

2017

Clinical Orthopaedics &Amp; Related Research

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Background Some leading anatomy texts state that all three heads of the triceps brachii are innervated by the radial nerve. The posterior cord of the brachial plexus bifurcates to terminate as the radial and axillary nerves. Studies have noted the presence of axillary innervation to the long head of the triceps brachii muscle, patterns different from the classic exclusive radial nerve supply. An understanding of these variations may assist the clinician in the assessment of shoulder weakness and in preoperative and operative planning of radial and axillary neuropathies. Questions/Purpose We aimed to further investigate, in cadaver dissections, the prevalence of axillary nerve contribution to the innervation of the long head of the triceps brachii. Methods We performed bilateral brachial plexus dissections on 10 embalmed cadavers combining anterior axillary and posterior subscapular approaches. Two additional unilateral cadaveric brachial plexuses were dissected. The posterior cords were fully dissected from the roots distally. The radial and axillary nerves were followed to their muscle insertion points, the dissections were photographed, and the length of branching segments were measured.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Variations in the Innervation of the Long Head of the Triceps Brachii: A Cadaveric Investigation

Erhardt

Futterman

2017

Clinical Orthopaedics &Amp; Related Research

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“…In a pathological entity called Quadrilateral Space Syndrome, the neurovascular compression can be assessed by the visualization of PCHA occlusion and stenosis by MRI, angiography and Ultrasound (Robinson et al). Axillary Nerve repair demands the correct identification of the structures that surround it, including PCHA (Bertelli et al, 2007). It is also a important anatomic reference for AN block in the quadrilateral space (Kim et al).…”

Section: Discussionmentioning

confidence: 99%

Output Relations of Humeral Circumflex Arteries and its Variations

Fontes¹,

Precht²,

Andrade³

et al. 2015

Int. J. Morphol.

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SUMMARY: A large range of variability marks the branching pattern of the axillary artery. The knowledge of the anatomical variations and this pattern is essential to diagnostic and therapeutic approaches, including surgery, of the axillary region. The aim of this study was to observe the different possible origins of circumflex humeral arteries and to measure the length and diameter of each vessel. In our study, 24 armpits from adult cadavers (fixed in tamponed formalin 10%) were dissected. The data were analyzed with a digital caliper and the results expressed as Mean ± SD. In majority of specimens, posterior circumflex humeral artery (PCHA) arose from subscapular artery (SSA) (54.16%) and had an average diameter of 3.92±0.41 mm. The anterior circumflex humeral artery was a branch from axillary artery (AA) in the majority of the specimens (62.5%) with an average diameter of 1.83±0.68 mm. Circumflex humeral arteries can arise from SSA, deep brachial artery and AA. The result of this study is an interesting data for origin, length and diameter of these vessels, contributing to the knowledge of these variations occurrence.

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“…31 Recently, successful neurotization using a branch of the radial nerve for the triceps muscle as donor was performed with very good results. 3,13,15,18,27 Finally, we reported a success rate of 78.6% with a novel method of axillary nerve reconstruction that uses the fascicle of the ulnar or median nerve. 9 Best results can be achieved in cases with a preserved proximal stump of the axillary nerve that can be reconstructed via end-to-end suturing using a short nerve graft.…”

mentioning

confidence: 99%

End-to-side neurorrhaphy in brachial plexus reconstruction

Haninec¹,

Mencl²,

Kaiser³

2013

JNS

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Object. Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy.Methods. From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window.Results. The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair.Conclusions. The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.

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Axillary nerve repair by triceps motor branch transfer through an axillary access: anatomical basis and clinical results

Abstract: The axillary nerve and its branches can be safely dissected and repaired by triceps motor nerve transfer through an axillary access.

Cited by 97 publications

References 29 publications

Variations in the Innervation of the Long Head of the Triceps Brachii: A Cadaveric Investigation

Variations in the Innervation of the Long Head of the Triceps Brachii: A Cadaveric Investigation

Output Relations of Humeral Circumflex Arteries and its Variations

End-to-side neurorrhaphy in brachial plexus reconstruction

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