Transfer of Pectoral Nerves to the Musculocutaneous Nerve in Obstetric Upper Brachial Plexus Palsy

Blaauw, G.; Slooff, A.C.J.

doi:10.1227/01.neu.0000073420.66113.66

Cited by 77 publications

(53 citation statements)

References 10 publications

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“…6 They performed the MPN transfer procedure in a relatively large number of patients and achieved excellent surgical outcomes. Their results corroborate those previously reported by Blaauw and Sloof 4 and make a strong case for MPN as a donor nerve that can be used in brachial plexus reconstruction for birth injury. The present report will serve as a valuable reference for many years.…”

supporting

confidence: 91%

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Medial pectoral nerve transfer

Park¹

2009

PED

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supporting

confidence: 91%

“…Branches from the pectoral nerves form a loop running from the lateral pectoral nerve to the MPN. 2,4 This plexiform arrangement can make it difficult to distinguish between the medial and lateral pectoral nerves. Additionally pectoral muscle contraction with direct stimulation allow identification of the proximal and distal stumps of the severed donor nerve.…”

mentioning

confidence: 99%

Medial pectoral nerve transfer

Park¹

2009

PED

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“…Many publications in the medical literature detail successful means of treatment of patients of all ages with injuries to the brachial plexus, most commonly interposition nerve grafting, neurotization utilizing the intercostal nerves, and, more recently, the Oberlin procedure. 5,11,16,18,25,26,28,29,33,34,36,37 Experienced peripheral nerve surgeons are required to adapt on a case-by-case basis based on preoperative recovery patterns and intraoperative observations (for example, length of available nerves for direct neurotization and availability of proximal roots for grafting).…”

Section: Discussionmentioning

confidence: 99%

Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience

Wellons¹,

Tubbs

Pugh³

et al. 2009

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Object Medial pectoral nerve (MPN) to musculocutaneous nerve (MCN) neurotization for recovery of elbow flexion by biceps reinnervation is a valid option following traumatic injury to the upper brachial plexus. A major criticism of the application of this technique in infants is the smaller size of the MPN and mismatch of viable axons. We describe our institutional experience utilizing this procedure and critically examine functional outcomes. Methods Office charts and hospital records of children from over an 11-year period beginning January 1997 were reviewed. Of the 53 children of various ages undergoing brachial plexus exploration for traumatic injury of any nature, 20 underwent MPN to MCN neurotization as a part of an overall procedure in the first year of life to treat birth-related brachial plexus palsy and had at least 9 months' follow-up. Medial pectoral nerve to MCN neurotization was chosen if the results of clinical examination and intraoperative electrophysiological evidence were consistent with medial cord function. Functional recovery was defined as the ability of the child to bring their hand to their mouth. Results Sixteen patients (80%) gained functional recovery. The median age at surgery was 7 months. Median time to first clinic visit documenting recovery was 11.5 months and median overall follow up was 21.5 months. Preoperative hand function was a useful predictor of recovery of elbow flexion. Conclusions Medial pectoral nerve to MCN neurotization is a valid surgical option for the reinnervation of the biceps muscle for birth-related brachial plexus palsy when the hand is functional preoperatively. Useful elbow flexion can be expected in the majority of these children.

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“…This muscle is innervated by the superior, medial and lateral pectoral nerves, allowing it to retain some function when one of its branches is used as a donor [108] (Figure 7). It provides acceptable results [45,63], but often a nerve graft is needed.…”

Section: Icn To Mcn Transfermentioning

confidence: 99%

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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Transfer of Pectoral Nerves to the Musculocutaneous Nerve in Obstetric Upper Brachial Plexus Palsy

Abstract: Transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric upper brachial palsy may be effective, if the specific anatomic features of the pectoral nerve plexus are sufficiently appreciated.

Cited by 77 publications

References 10 publications

Medial pectoral nerve transfer

Medial pectoral nerve transfer

Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

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