Restoration of Prehension with the Double Free Muscle Technique Following Complete Avulsion of the Brachial Plexus

Doi, Kazuteru; Muramatsu, Keiichi; Hattori, Yasunori; Otsuka, Ken; Sheng, T. T.; Nanda, Vipul; Watanabe, Masayuki

doi:10.2106/00004623-200005000-00006

Cited by 203 publications

(128 citation statements)

References 16 publications

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“…Since we routinely performed the doublefree muscle technique to reconstruct function of the elbow and fingers, 12 the target nerves were always the suprascapular nerve or the upper trunk for reconstruction of shoulder stability. Evidence of the re-innervation of the supraspinatus and infraspinatus muscles was obtained using needle electromyograms within four to six months in all cases.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Choline acetyltransferase activity and evoked spinal cord potentials for diagnosis of brachial plexus injury

Hattori¹,

Doi²,

Dhawan³

et al. 2004

The Journal of Bone and Joint Surgery. British volume

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he purpose of this study is to investigate the diagnostic value of evoked spinal cord potentials (ESCPs) and choline acetyltransferase (CAT) activity during exploration of injuries to the brachial plexus. We assessed 25 spinal roots in 19 patients. The results of the two investigations were consistent in all except two roots. Although assessment of ESCPs is easy and quick, it mainly records the nerve potentials along the sensory pathway. Although measurement of CAT activity needs a specimen of the nerve and the availability of a radioisotope laboratory, it gives direct information regarding the motor function of ventral spinal roots. These two techniques should be complementary to each other in order to achieve a more accurate diagnosis.

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Section: Resultsmentioning

confidence: 99%

“…12 However, no method of reconstruction can achieve more than 90˚ of abduction of the shoulder. 16 Chuang et al, 16 noted that the simultaneous neurotisation of the suprascapular and axillary nerves with the phrenic and spinal accessory nerves was the most reliable option.…”

Section: Discussionmentioning

confidence: 99%

Choline acetyltransferase activity and evoked spinal cord potentials for diagnosis of brachial plexus injury

Hattori¹,

Doi²,

Dhawan³

et al. 2004

The Journal of Bone and Joint Surgery. British volume

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“…In late brachial plexus cases, when native muscle targets have been wasted, free muscle transfer innervated by intercostal nerves seem to be a viable procedure [16,18,[35][36][37][38][39] . When planning a muscle transfer for upper extremity reanimation, in order to obtain the maximum result it is imperative to choose the correct muscle for needed function.…”

Section: Discussionmentioning

confidence: 99%

Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

Lykissas

Kostas-Agnantis²,

Korompilias³

et al. 2013

WJO

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Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles (i.e. , latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration.

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“…Another advantage is the use of limited motor donors for simultaneous movement of multiple joints [16,18]. However, Landsmeer [25] showed that to control two joints of a multiarticular chain in all positions at least three muscles are necessary; all three may cross two joints, or two may be biarticular and one monoarticular.…”

Section: One Muscle Transfer For Simultaneous Reconstruction Of Two Fmentioning

confidence: 99%

Free Muscle Transfer in Posttraumatic Plexopathies Part II: The Elbow

Terzis¹,

Kostopoulos

2009

Hand (New York, N,Y.)

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The indications for free muscle transfer in brachial plexopathies are prolonged denervation time or inadequate upper extremity function after primary nerve reconstruction. The purpose of this study is to analyze the outcomes of free muscle transfer for elbow flexion and extension in brachial plexopathies in relation to the different muscles used and the respective motor donors. Seventy-three muscles were transferred for elbow flexion and ten for elbow extension. Latissimus dorsi (LD) was used in 37 cases, gracilis in 28, rectus femoris (RF) in seven, and vastus lateralis in one. Five LD and five gracilis were transferred for elbow extension. Patients younger than 15 years yielded better results than older patients for elbow flexion. When LD was transferred, the mean muscle grading (MG) was 3.33±0.25 when the neurotization was from intercostals; these outcomes were statistically significant when compared with outcomes of free gracilis transfer (MG 2.25±0.6). There was also a statistically significant difference when free LD was neurotized with three intercostals as compared with two intercostals nerves. RF yielded also good results when neurotized from contralateral C7 (cC7; MG 3.67±0.6). For elbow extension, the better outcomes of LD were not statistically significant. Among all the free muscle transfers for upper extremity reconstruction, elbow reanimation yielded the most rewarding outcomes. The selection of powerful muscle units was more important than the effect of neurotization which was not as strong as it was in muscle transfers for facial or hand reanimation.

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Restoration of Prehension with the Double Free Muscle Technique Following Complete Avulsion of the Brachial Plexus

Cited by 203 publications

References 16 publications

Choline acetyltransferase activity and evoked spinal cord potentials for diagnosis of brachial plexus injury

Choline acetyltransferase activity and evoked spinal cord potentials for diagnosis of brachial plexus injury

Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

Free Muscle Transfer in Posttraumatic Plexopathies Part II: The Elbow

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