Kevin J Little1, Dan A Zlotolow2, Francisco Soldado3, Roger Cornwall1, Scott H Kozin2. 1. Division of Orthopaedic Surgery, University of Cincinnati School of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for K.J. Little: kevin.little@cchmc.org. 2. Shriner's Hospital for Children of Philadelphia, Temple University School of Medicine, 3551 North Broad Street, Philadelphia, PA 19140. 3. Pediatric Hand Surgery and Microsurgery, Orthopaedic Surgery Department, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain.
Abstract
INTRODUCTION: Transfer of a fascicle of the ulnar and/or median nerve to the musculocutaneous nerve in order to reinnervate the biceps and/or brachialis muscles has a high success rate and a low rate of complications in infants with upper (C5-C6) or extended upper (C5-C7) neonatal brachial plexus palsy. STEP 1 MAKE THE INCISION: Make a longitudinal incision along the midline of the middle third of the medial brachium. STEP 2 MOBILIZE THE MUSCULOCUTANEOUS NERVE: The musculocutaneous nerve is typically found on the undersurface of the biceps muscle. STEP 3 MOBILIZE THE MEDIAN NERVE: The median nerve runs along the neurovascular sheath medial to the brachial artery. STEP 4 MOBILIZE THE ULNAR NERVE: The ulnar nerve lies posterior to the intermuscular septum. STEP 5 TRANSFER THE DONOR NERVE TO THE RECIPIENT NERVE: Cut the donor fascicles distally and the recipient fascicles proximally to facilitate transfer. STEP 6 CLOSE THE WOUND: Irrigate the wound, and close it in layers. STEP 7 POSTOPERATIVE PROTOCOL: Remove the bandages two weeks postoperatively, and encourage passive range-of-motion exercises. RESULTS: In our series, thirty-one patients underwent single or combined nerve fascicle transfer; twenty-seven (87%) obtained functional elbow flexion recovery (Active Movement Scale [AMS] score ≥ 6) while twenty-four (77%) obtained full elbow flexion recovery (AMS score = 7). Indications Contraindications Pitfalls & Challenges.
INTRODUCTION: Transfer of a fascicle of the ulnar and/or median nerve to the musculocutaneous nerve in order to reinnervate the biceps and/or brachialis muscles has a high success rate and a low rate of complications in infants with upper (C5-C6) or extended upper (C5-C7) neonatal brachial plexus palsy. STEP 1 MAKE THE INCISION: Make a longitudinal incision along the midline of the middle third of the medial brachium. STEP 2 MOBILIZE THE MUSCULOCUTANEOUS NERVE: The musculocutaneous nerve is typically found on the undersurface of the biceps muscle. STEP 3 MOBILIZE THE MEDIAN NERVE: The median nerve runs along the neurovascular sheath medial to the brachial artery. STEP 4 MOBILIZE THE ULNAR NERVE: The ulnar nerve lies posterior to the intermuscular septum. STEP 5 TRANSFER THE DONOR NERVE TO THE RECIPIENT NERVE: Cut the donor fascicles distally and the recipient fascicles proximally to facilitate transfer. STEP 6 CLOSE THE WOUND: Irrigate the wound, and close it in layers. STEP 7 POSTOPERATIVE PROTOCOL: Remove the bandages two weeks postoperatively, and encourage passive range-of-motion exercises. RESULTS: In our series, thirty-one patients underwent single or combined nerve fascicle transfer; twenty-seven (87%) obtained functional elbow flexion recovery (Active Movement Scale [AMS] score ≥ 6) while twenty-four (77%) obtained full elbow flexion recovery (AMS score = 7). Indications Contraindications Pitfalls & Challenges.
Authors: Kevin J Little; Dan A Zlotolow; Francisco Soldado; Roger Cornwall; Scott H Kozin Journal: J Bone Joint Surg Am Date: 2014-02-05 Impact factor: 5.284