Nerve Transfer of Brachialis Branch to Anterior Interosseus Nerve Using In Situ Lateral Antebrachial Cutaneous Nerve Graft in Tetraplegia

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Waris , E , Palmgren-Soppela , T & Sommarhem , A 2022 , ' Nerve Transfer of Brachialis Branch to Anterior Interosseus Nerve Using In Situ Lateral Antebrachial Cutaneous Nerve Graft in Tetraplegia ' , Journal of Hand Surgery , vol. 47 , no. 4 , pp. 390.e1-390.e7 . https://doi.org/10.1016/j.jhsa.2021.04.037

Title: Nerve Transfer of Brachialis Branch to Anterior Interosseus Nerve Using In Situ Lateral Antebrachial Cutaneous Nerve Graft in Tetraplegia
Author: Waris, Eero; Palmgren-Soppela, Tove; Sommarhem, Antti
Contributor organization: Clinicum
I kirurgian klinikka (Töölö)
HUS Musculoskeletal and Plastic Surgery
HUS Children and Adolescents
Lastenkirurgian yksikkö
Date: 2022-04
Language: eng
Number of pages: 7
Belongs to series: Journal of Hand Surgery
ISSN: 0363-5023
DOI: https://doi.org/10.1016/j.jhsa.2021.04.037
URI: http://hdl.handle.net/10138/346511
Abstract: Purpose: Reconstruction of finger motion is a therapeutic goal in tetraplegic patients. Although nerve transfer of the brachialis branch of the musculocutaneous nerve to the anterior interosseus nerve has been previously described, this results in unreliable reinnervation because the donor nerve is proximal to the target muscle. We describe an alternative technique in which nerve transfer is performed using the lateral antebrachial cutaneous nerve as a vascular in situ nerve graft. The clinical results are reported. Methods: Nine upper limbs of 6 patients (mean age 25 years) with tetraplegia were subjected to brachialis-to-anterior interosseus nerve transfer using the lateral antebrachial cutaneous nerve as a vascular in situ nerve graft, at a mean of 6 months after injury. Additional supinator branch transfer to the posterior interosseous nerve was performed for 6 upper limbs and to the flexor digitorum superficialis motor branch for 1 upper limb. Results: At a mean of 2 years of follow-up, thumb and finger flexion strength scored M3-M4 in 5 of the 9 limbs according to the Medical Research Council scale. Key pinch and grip pinch averaged 0.6 kg (range, 0–1.0 kg) and 2.2 kg (range, 0–8 kg), respectively. No donor-site deficit was observed. Conclusions: Brachialis-to-anterior interosseus nerve transfer with an in situ lateral antebrachial cutaneous nerve graft can be used to reconstruct thumb and finger flexion in tetraplegic patients. Combined with supinator-to- posterior interosseous nerve transfer, simultaneous active extension of the fingers can be achieved. Type of study/level of evidence: Therapeutic V.
Description: Publisher Copyright: © 2021 American Society for Surgery of the Hand
Subject: 3126 Surgery, anesthesiology, intensive care, radiology
Brachialis
graft
in situ
nerve transfer
tetraplegia
HAND FUNCTION
MUSCULOCUTANEOUS NERVE
SPINAL-CORD-INJURY
RESTORATION
EXTENSION
SUPINATOR
FINGER FLEXION
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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