Cross pectoral nerve transfer following free gracilis muscle transplantation for chronic brachial plexus palsy: A case series

Hosseinian, Mohammad Ali; Tofigh, Arash Mohammadi

doi:10.1016/j.ijsu.2008.01.004

Cited by 17 publications

(8 citation statements)

References 12 publications

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“…The term inferior PN was defined as arising from the lower trunk (C8 and T1) (Aszmann et al,2000; Lee,2007). The superior and middle PNs probably correspond to the LPN as Hovelacque (1927) had previously specified that the nerve of the major pectoral muscle (i.e., the LPN) may be double, with a superior and an inferior nerve, while the nerve of the minor pectoral muscle (i.e., the MPN) is usually single.…”

Section: Origin and Constitutionmentioning

confidence: 99%

“…Apart from the above patterns of innervation of the pectoral muscles by the PNs, some reports are present in the literature of these nerves innervating other muscles. Both the subclavius muscle and the anterior portion of the deltoid muscle have been reported to be occasionally innervated by branches arising from the LPN (Hovelacuqe,1927; Solomon et al,1997).…”

Section: Motor Innervationmentioning

confidence: 99%

“…In the first part of the procedure, a sural nerve graft is sutured to the contralateral MPN and passed through a subcutaneous tunnel to the medial side of the injured arm. After 12 to 24 months, the second stage consists of transfer of the gracilis myocutaneous flap, then the sural nerve stump neuroma is finally resected and the nerve is sutured to the motor nerve of the transferred muscle (Hosseinian and Tofigh,2008; Gousheh and Arasteh,2010). Innervation of a free gracilis muscle flap has also been achieved using branches of the LPN (Stockinger et al,2008).…”

Section: Motor Innervationmentioning

confidence: 99%

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Surgical anatomy of the pectoral nerves and the pectoral musculature

et al. 2011

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The pectoral nerves (PNs) may be selectively injured through various traumatic mechanisms such as direct trauma, hypertrophic muscle compression, and iatrogenic injuries (breast surgery and axillary node dissection, pectoralis major muscle transfers). The PN may be surgically recovered through nerve transfers. They may also be used as donors to the musculocutaneous, axillary, long thoracic, and spinal accessory nerves and for reinnervation of myocutaneous free flaps. Thus, in this article, we reviewed the surgical anatomy of PN. A meta-analysis of the available literature showed that the lateral pectoral nerve (LPN) arises most frequently with two branches from the anterior divisions of the upper and middle trunks (33.8%) or as a single root from the lateral cord (23.4%). The medial pectoral nerve (MPN) usually arises from the medial cord (49.3%), anterior division of the lower trunk (43.8%), or lower trunk (4.7%). The two PN are usually connected immediately distal to the thoracoacromial artery by the so-called ansa pectoralis. The MPN may also show communications with the intercostobrachial nerve. In 50%-100% of cases, it may pass, at least with some branches, through the pectoralis minor muscle. The LPN supplies the upper portions of the pectoralis major muscle; the MPN innervates the lower parts of the pectoralis major and the pectoralis minor muscle. Among the accessory muscles of the pectoral girdle, the LPN may also innervate the tensor semivaginae articulationis humero-scapularis, pectoralis minimus, sternoclavicularis, axillary arch, sternalis, and infraclavicularis muscles; the MPN may innervate the pectoralis quartus, chondrofascialis, axillary arch, chondroepitrochlearis, and sternalis muscles.

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Section: Origin and Constitutionmentioning

confidence: 99%

Section: Motor Innervationmentioning

confidence: 99%

Section: Motor Innervationmentioning

confidence: 99%

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Surgical anatomy of the pectoral nerves and the pectoral musculature

et al. 2011

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“…Global BPI can be treated within one year with nerve transfer procedures such as the contralateral C7 (CC7), phrenic, spinal accessory, intercostal nerve, and motor nerve of the cervical plexus 1 .…”

mentioning

confidence: 99%

Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients

Yang

et al. 2016

Sci Rep

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In the study, the functional recovery and relative comprehensive quality of life of cases of global brachial plexus treated with free functioning muscle transfers were investigated. Patients who received functioning gracilis muscle transfer between August 1999 and October 2014 to reconstruct elbow flexion, wrist and fingers extension were recruited. The mean age of the patients was 26.36 (range, 16–42) years. The mean period of time from gracilis transfer to the last follow-up was 54.5 months (range, 12–185 months). Muscle power, active range of motion of the elbow flexion, wrist extension, and total active fingers extension were recorded. SDS, SAS and DASH questionnaires were given to estimate patients’ quality of life. 35.71% reported good elbow flexion and 50.00% reported excellent elbow flexion. The average ROM of the elbow flexion was 106.5° (range, 0–142°) and was 17.00° (range, 0–72°) for wrist extension. The average DASH score was 51.14 (range, 17.5–90.8). The prevalence of anxiety and depression were 42.86% and 45.24%. Thrombosis and bowstringing were the most common short and long-term complications. Based on these findings, free gracilis transfer using accessory nerve as donor nerve is a satisfactory treatment to reconstruct the elbow flexion and wrist extension in global-brachial-plexus-injured patients.

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“…The explanation is that they were working on clean wounds and not infected and neglected posttraumatic cases, as ours, with a higher risk of complications and even failure. For the same reason, Hosseinian and Tofigh [19] had no complications at all. In addition, the mean age of their patients was lower than ours (25 vs. 33 years).…”

Section: Discussionmentioning

confidence: 82%

Binocular single-refraction magnifying glasses for free flap surgery: a reliable method for developing countries

2012

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Although free flaps are gaining more popularity, the logistic reasons and slow training curve are still major obstacles, particularly in developing countries. Binocular magnification glasses seemed an appealing alternative to surgical microscopes and loupes. From May 2008 to December 2010, 16 gracilis free flaps were performed by five surgeons using binocular-magnifying eye glass in the Plastic Surgery Unit of Suez Canal University Hospital. Survival rate of the flaps was 100%. Only two patients (one smoker and one diabetic) had complications: partial flap loss with infection and hematoma. Both were treated conservatively. The main advantages of this magnification method were very low cost, availability, and short training period compared with a standard microsurgery training. Other advantages were the freedom of movement during operation, same orientation, wide field, adjustability of working distance, and permission of team work. The only inconvenience was the restriction of working distance, although longer or similar to that of loupes. We therefore recommend the use of this method in developing countries as well as relief and war field hospitals. Furthermore, these glasses seem to be of value in all surgeries needing magnification.

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Cross pectoral nerve transfer following free gracilis muscle transplantation for chronic brachial plexus palsy: A case series

Cited by 17 publications

References 12 publications

Surgical anatomy of the pectoral nerves and the pectoral musculature

Surgical anatomy of the pectoral nerves and the pectoral musculature

Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients

Binocular single-refraction magnifying glasses for free flap surgery: a reliable method for developing countries

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