Selective Neurotization of the Median Nerve in the Arm to Treat Brachial Plexus Palsy

Fascicular Selection for Nerve Transfers: The Role of the Nerve Stimulator When Restoring Elbow Flexion in Brachial Plexus Injuries

“…We believe that most of the problems in donor nerves are related to inclusion of more than a single fascicle at the time of transfer. The postoperative results in elbow flexion strength, grip and pinch strengths, and sensory deficits were comparable to all other reported series 16,21 in which double nerve transfers were performed in upper brachial plexus injuries, except the study reported by Liverneaux et al 15 Zhao et al 26 described the details of fascicular arrangements in median nerve. In the distal arm, the branches of median nerve consistently aggregate into 3 fascicular groups located at the anterior, middle, and posterior parts of the nerve.…”

An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection

“…This could facilitate manipulation during harvesting of the thoracic phrenic nerve via video-assisted thoracic surgery. Comparison between the length of the full phrenic nerve and its thoracic part on both sides, revealed that harvesting of the full-length phrenic nerve provided an extension of 16.8 and 23.2 cm on the right and left side, respectively, for a distant neurotization to the radial nerve in the axilla (Yang et al 2011), the median nerve in the arm (Zhao et al 2004;Zhao et al 2005), or the innervated free functional muscle in the forearm (Chuang and Mardini 2003) with a much shorter nerve graft. Also, the lengths on the left side were about 6 cm longer than those on the right side in both cases, which could be explained by the two-intercostalspace elevation of the diaphragm due to the liver on the right side, suggesting that there are clinical implications associated with the careful positioning of thoracoscopic portals to harvest the thoracic phrenic nerve, as indicated by iatrogenic injuries to the right diaphragm due to portals placed in the seventh intercostal space of the three corpses with elevated diaphragms on the right side.…”

A computational model and simulation study of the efferent activity in the brachial nerves during voluntary motor intent

“…From the literature, it was determined that these muscles of the forearm are sufficiently independent for multifunctional control [31]. The functional nerve fascicles corresponding to these muscles [1,21,28,29,35,36] are also listed in Table 1.…”

“…This level is at the 1/8-arm length distal to the level of the medial epicondyle [29,35]. Histomorphological data, including the fascicular areas and the fiber numbers, are Table 1 The articulations considered in the simulation model, with the prime mover muscles and the corresponding motor nerve supply presented in the literature as well [29], which facilitate the establishment of nerve models in this simulation.…”

“…Evidence from research on a series of dissections from diverse cadavers demonstrated that the endoneural fascicle organization has a particular order, termed somatotopic organization. This concept was first introduced by Sunderland [27], and in the following decades, further studies supported this concept [18,26,29,35]. This somatotopic organization results in the functional grouping among fibers within the nerve trunk, i.e., topographic arrangements that exist according to the terminations of nerve fibers.…”