Complications of Intercostal Nerve Transfer for Brachial Plexus Reconstruction

Kovachevich, Rudy; Kircher, Michelle F.; Wood, Christina M.; Spinner, Robert J.; Bishop, Allen T.; Shin, Alexander Y.

doi:10.1016/j.jhsa.2010.09.013

Cited by 47 publications

(20 citation statements)

References 39 publications

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“…The present data indicate that intercostal nerves, which was used in the first surgical procedure since there were no concomitant chest trauma (25), support important function as coughing, while the phrenic nerve is crucial for deep breathing. We suggest that the training of patients, in whom transfer of intercostal nerves has been performed, should concentrate to transfer coughing function to the biceps brachii muscle, which is in contrast to a previous study, suggesting trunk flexion during training of the new function in order to facilitate elbow flexion (24).…”

Section: Discussionmentioning

confidence: 67%

Rehabilitation, Using Guided Cerebral Plasticity, of a Brachial Plexus Injury Treated with Intercostal and Phrenic Nerve Transfers

et al. 2017

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Recovery after surgical reconstruction of a brachial plexus injury using nerve grafting and nerve transfer procedures is a function of peripheral nerve regeneration and cerebral reorganization. A 15-year-old boy, with traumatic avulsion of nerve roots C5–C7 and a non-rupture of C8–T1, was operated 3 weeks after the injury with nerve transfers: (a) terminal part of the accessory nerve to the suprascapular nerve, (b) the second and third intercostal nerves to the axillary nerve, and (c) the fourth to sixth intercostal nerves to the musculocutaneous nerve. A second operation—free contralateral gracilis muscle transfer directly innervated by the phrenic nerve—was done after 2 years due to insufficient recovery of the biceps muscle function. One year later, electromyography showed activation of the biceps muscle essentially with coughing through the intercostal nerves, and of the transferred gracilis muscle by deep breathing through the phrenic nerve. Voluntary flexion of the elbow elicited clear activity in the biceps/gracilis muscles with decreasing activity in intercostal muscles distal to the transferred intercostal nerves (i.e., corresponding to eighth intercostal), indicating cerebral plasticity, where neural control of elbow flexion is gradually separated from control of breathing. To restore voluntary elbow function after nerve transfers, the rehabilitation of patients operated with intercostal nerve transfers should concentrate on transferring coughing function, while patients with phrenic nerve transfers should focus on transferring deep breathing function.

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Section: Discussionmentioning

confidence: 67%

Rehabilitation, Using Guided Cerebral Plasticity, of a Brachial Plexus Injury Treated with Intercostal and Phrenic Nerve Transfers

et al. 2017

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“…Es mandatorio informar a cada paciente sobre los riesgos y los beneficios de cada procedimiento y, por lo tanto, es importante conocer las potenciales complicaciones de los mismos. La mayoría de los reportes sobre cirugía del plexo braquial apuntan a evaluar los pronósticos y resultados de las diferentes técnicas que se pueden usar y hay muy pocos reportes que estudien únicamente las complicaciones 5 .…”

Section: Discussionunclassified

“…Algunas complicaciones están directamente relacionadas con el tipo de abordaje usado, por ejemplo, los desgarros pleurales en las cirugías que usan nervios intercostales como donantes 5 .…”

Section: Tabla 1 -Complicaciones De La Cirugía Del Plexo Braquialunclassified

“…Kovachevich et al 5 analizan las complicaciones asociadas al uso de nervios intercostales como donantes. Encuentran 23 complicaciones en 153 procedimientos (15%).…”

Section: Tabla 1 -Complicaciones De La Cirugía Del Plexo Braquialunclassified

“…Extrapolando cifras de España, en Uruguay se presentarán entre 12 y 24 casos por año de traumatismos cerrados de plexo braquial 3 . Teniendo en cuenta el aumento de la siniestralidad vial, es probable que en los próximos años presenciemos un aumento de este tipo de lesiones, que tienen un efecto devastador sobre la funcionalidad del miembro superior 4,5 .…”

Section: Introductionunclassified

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