Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Abstract

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.

Phrenic Nerve Reconstruction for Effective Surgical Treatment of Diaphragmatic Paralysis

“…Complete transection of the phrenic nerve from an acute iatrogenic or traumatic event a rare reported occurrence given its somewhat inaccessible location in both the cervical and thoracic regions. [23][24][25] The nerve is deep to the prevertebral fascia and lateral to the carotid sheath in the neck, and medial to the lung within the pericardial fat along the mediastinal and thoracic course. More commonly, the phrenic nerve and the dominant nerve root contributions (C4-5) are susceptible to compression from adjacent fibrous, muscular, and vascular adhesions, a process not dissimilar to generally recognized compression neuropathies of the brachial plexus and upper extremity.…”

“…The pathophysiology of phrenic neuropathy resulting in diaphragmatic paralysis varies based upon the mechanism of injury. Complete transection of the phrenic nerve from an acute iatrogenic or traumatic event is a rare reported occurrence given its somewhat inaccessible location in both the cervical and thoracic regions 23–25 . The nerve is deep to the prevertebral fascia and lateral to the carotid sheath in the neck, and medial to the lung within the pericardial fat along the mediastinal and thoracic course.…”

Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

“…e PT branch is not very recommended as a donor for reinnervation because pronation is essential for many daily living activities and because this muscle can be used for a tendon transfer in case the nerve transfer is unsuccessful. [31] Transfer: Supinator motor branch to PIN After the transfer of brachialis to the AIN, the rotation and pronation of the forearm is performed. A longitudinal incision was performed on the proximal third of the dorsal forearm.…”

“…To try to recover the ulnar motor function, AIN to ulnar transfer was performed in a second surgical time, between 4 and 6 months later. e surgical technique proposed by Brown et al was performed, associated with a Taleisnik incision [31] (7 mm to the ulnar side of the thenar crease) to access the Guyon's canal. In this case, AIN motor branch related to innervation of the pronator quadratus was used as a motor component of the ulnar nerve [8] [Figure 3].…”