Nerve Transfers: Indications, Techniques, and Outcomes

Tung, Thomas H.; Mackinnon, Susan E.

doi:10.1016/j.jhsa.2009.12.002

Cited by 248 publications

(187 citation statements)

References 37 publications

(30 reference statements)

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“…Recently, some groups advocate that reinervation of the brachial plexus shall be restricted to nerve transfer surgery, avoiding proximal spinal nerve grafting 14 . Our results suggested the opposite: cases submitted to reconstruction solely and those who underwent nerve transfer associated to reconstruction demonstrated statistically significant better results than those in which nerve transfer solely was chosen as surgical strategy.…”

Section: Discussionmentioning

confidence: 99%

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Flores¹

2011

Arq. Neuro-Psiquiatr.

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Objective:The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. Method: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. Results: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. Conclusion: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand. Key words: brachial plexus surgery, nerve grafting, nerve transfer, palsy.Cirurgia do plexo braquial: o papel da técnica cirúrgica para a obtenção de melhores resultados funcionais RESUMO Objetivo: Análise de resultados das técnicas que comprovadamente melhoraram o prognóstico funcional de pacientes com lesões traumáticas do plexo braquial. Método: Estudo retrospectivo de cem casos de lesões traumáticas do plexo braquial. Foi realizada comparação dos resultados pós-operatórios obtidos com as diferentes técnicas utilizadas. Resultados: A técnica de enxertia a partir de raízes proximais resultou em bons graus de reinervação em 70% dos casos. Bons resultados (p<0,05) também foram relacionados à técnica de Oberlin e de Sansak, enquanto que a transferência frênico-musculocutâneo e acessório-suprascapular não resultaram em melhora que atingisse significância estatística. Reinervação motora da mão foi observada em menos de 30% dos casos. Conclusão: A cirurgia de reinervação do plexo braquial em geral resulta em boa recuperação da função proximal do membro, porém esses mesmos bons resultados não são observados em termos de reinervação da mão. Palavras-chave: cirurgia de plexo braquial, enxertos nervosos, transferência de nervos, paralisia.

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Section: Discussionmentioning

confidence: 99%

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Flores¹

2011

Arq. Neuro-Psiquiatr.

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“…Der bestmögliche Zeitpunkt für die chirurgische Intervention bei Patienten, die keine adäquate Reinnervation zeigen, liegt innerhalb weniger Monate [7]. Ein zu langes Abwarten kann unnötiger-weise zu einem Verlust der motorischen Endplatten und somit zum Scheitern der Reinnervation führen.…”

Section: Zeitpunkt Der Operativen Behandlungunclassified

Operative Optionen bei Plexusverletzungen der oberen Extremität

Schreier

Malat

Homann

2017

Trauma Berufskrankh

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“…Although regeneration is good to excellent for bridged nerve gaps <2 cm in length [95][96][97][98][99][100][101], it becomes increasingly limited as bridged gaps reach 4 cm in length [97,100], and decreases significantly with increasing graft length, with few axons regenerating across grafts of 8 cm in length [95,98,99,102], and no regeneration is seen for gaps more than 10 cm in length [30,[102][103][104][105][106].…”

mentioning

confidence: 99%

“…The extent of neurological recovery decreases with increasing patient age, with best recovery being for patients up to 20-25 years of age [97,105,[112][113][114][115][116][117]. Similar decreases in the efficacy of axon regeneration are seen for rats with increasing age [118].…”

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confidence: 99%

Promoting Axon Regeneration and Neurological Recovery Following Traumatic Peripheral Nerve Injuries

Kuffler¹

2015

Int J Neurorehabilitation Eng

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Repairing Peripheral Nerves following Traumas Nerve crushWithin several days of crushing a peripheral nerve, the injured axons begin to regenerate through their distal pathway until they reach their original targets with which they restore neurological function. The larger the number of axons that regenerate through the distal nerve, the greater the extent of neurological recovery [1][2][3]. The number of axons that regenerate, and thus neurological recovery, is influenced by the physiological state of the distal denervated nerve pathway [4][5][6][7].Following a peripheral nerve crush, the injured axons begin to regenerate within 2 days of injury [8]. They may regenerate to their targets through their original pathway in association with and promoted by its Schwann cells, the neurotrophic factors they release, and the Schwann cell extracellular matrix [1,4,[9][10][11][12][13][14]. Thus, the distal nerve provides a simple means for promoting and directing the regenerating axons to their original targets [15][16][17][18]. However, when a nerve has a gap, the gap must be bridged with a material that is permissive to and promotes axon regeneration across the entire gap to reach the distal nerve stump, through which the axons must then be able to regenerate.The Schwann cells in the denervated distal nerve release neurotrophic factors that promote axon regeneration, but also release extracellular matrix components that promote and inhibit axon regeneration [19][20][21][22][23][24][25][26]. Thus, regeneration through the distal nerve is a balance of the influences of factors that both promote and inhibit regeneration. If the Schwann cells are present, such as after a simple nerve crush, virtually 100% of the axons regenerate and they innervate all the denervated synaptic sites. If the Schwann cells within the distal nerve pathway are killed, leaving only the extracellular matrix intact, the number of axons that regenerates to their targets decreases by 94%. This is because the factors required to trigger the regenerating axons to branch at extracellular matrix branch points are missing, axons do not branch, and therefore each axon reinnervates only a single denervated muscle fiber. Thus, Schwann cells along the distal nerve pathway and a AbstractFollowing a peripheral nerve crush, or when a peripheral the nerve is transected and the nerve stumps anastomosed, neurological recovery is generally excellent. This is because the axons merely have to regenerate through the distal portion of the nerve through the existing extracellular matrix of the denervated Schwann cells that direct and promote them to their distant denervated motor and sensory targets. However, when a length of a peripheral nerve is destroyed, and anastomosis is not possible, the standard surgical repair technique is to graft a length/s of autologous sensory nerve into the gap. Neurological recovery is generally good if the nerve gap is <2 cm in length, the repair is performed <4 months post trauma, and the patients are <25 years of age. Because the nerve ...

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Nerve Transfers: Indications, Techniques, and Outcomes

Cited by 248 publications

References 37 publications

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Operative Optionen bei Plexusverletzungen der oberen Extremität

Promoting Axon Regeneration and Neurological Recovery Following Traumatic Peripheral Nerve Injuries

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