Intercostal Nerve Transfer to Neurotize the Musculocutaneous Nerve after Traumatic Brachial Plexus Avulsion: A Comparison of Two, Three, and Four Nerve Transfers

Xiao, Chengwei; Lao, Jie; Wang, Tao; Zhao, Xin; Liu, Jingbo; Gu, Yajia

doi:10.1055/s-0033-1361840

Cited by 37 publications

(22 citation statements)

References 23 publications

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“…Stabilization of the shoulder was achieved with the first two mentioned transfers at the initial procedure, while the conventional transfer of three intercostal nerves to the biceps brachii muscle was insufficient to restore elbow function (M1–2) in the present case (8). In the second procedure, it was necessary to do a free gracilis muscle transfer with the intention to improve elbow flexion (14–16).…”

Section: Discussionmentioning

confidence: 61%

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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: 61%

“…Intercostal nerves are commonly used to reinnervate muscles after a BPI with avulsion of spinal nerve roots (5–7); where two intercostal nerves should be enough for reinnervation of a muscle (8). Intercostal nerves can be harvested without any residual problems, e.g., pulmonary dysfunction (9).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…The results are only fair, but can be the only choice in five root brachial plexus avulsion [105][106][107].…”

Section: Icn To Mcn Transfermentioning

confidence: 99%

“…At least two of them per recipient nerve are needed [24,124]. They have been used to re-innervate many nerves, like the AXN [89,92], MCN [24,105,106,[124][125][126], TLH [92,118,119], TDN [89,127] and SSN [90,91]. Their sensory branches can be used to recover some limb sensation, ameliorating the neuropathic pain.…”

Section: Intercostal Nerve Transfersmentioning

confidence: 99%

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Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Vanaclocha‐Vanaclocha¹,

Ortiz-Criado²,

NievesSáiz-Sapena³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Successful re-innervation of proximal limb peripheral nerve injuries is rare. Axons regenerate at ~1 mm/day, reaching hand muscles by 24 months, finding them atrophied and fibrosed. Peripheral nerve injury repair is often delayed waiting for spontaneous recovery. This waiting time should not be longer than 6 months as after 18 months reinnervation will not achieve effective muscular function. When spontaneous recovery is impossible, referral too late or damage too severe, other options like a transfer from a nearby healthy nerve to the injured one must be considered. They are very successful, and the deficit in the donor site is usually minimal. The most common nerve transfers are a branch of the spinal nerve to the trapezius muscle to the suprascapular nerve, a branch of the long head of the triceps to the axillary nerve, a fascicle of the ulnar nerve to the motor branch of the biceps muscle, two branches of the median nerve to the posterior interosseous nerve and the anterior interosseous nerve to the ulnar nerve. There are many more options that can suit particular cases. Introduced in brachial plexus injury repair, they are now also applied to lower limb, to stroke and to some spinal cord injuries.

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Intercostal nerve transfer to the biceps motor branch in complete traumatic brachial plexus injuries

et al. 2015

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The purpose of this report is to critically evaluate our results of two intercostal nerve transfers directly to the biceps motor branch in complete traumatic brachial plexus injuries. From January 2007 to November 2012, 19 patients were submitted to this type of surgery, but only 15 of them had a follow-up for ≥2 years and were included in this report. The mean interval from trauma to surgery was 6.88 months (ranging from 3 to 9 months). Two intercostals nerves were dissected and transferred directly to the biceps motor branch. The mean follow-up was 38.06 months (ranging from 24 to 62 months). Ten patients (66.6%) recovered an elbow flexion strength ≥M3. Four of them (26.66%) recovered a stronger elbow flexion ≥M4. One patient (6.25%) recovered an M2 elbow flexion and four patients (26.66%) did not regain any movement. We concluded that two intercostal nerve transfers to the biceps motor branch is a procedure with moderate results regarding elbow flexion recovery, but it is still one of the few options available in complete brachial plexus injuries, especially in five roots avulsion scenario.

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Intercostal Nerve Transfer to Neurotize the Musculocutaneous Nerve after Traumatic Brachial Plexus Avulsion: A Comparison of Two, Three, and Four Nerve Transfers

Cited by 37 publications

References 23 publications

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

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

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Intercostal nerve transfer to the biceps motor branch in complete traumatic brachial plexus injuries

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