Preserved Finger Flexion in Brachial Plexus Total Lesion: A Study of 16 Cases Among 989 Surgical Patients.

Purpose: Brachial plexus traction injuries have conventionally been categorized as involving the C5-C6, C5-C7, C5-T1, and C8-T1 roots. In this article, we report a distinct clinical presentation of brachial plexus injury characterized by intact finger flexion with signs of complete brachial plexus injury.

Methods: From 2010 to 2022, 989 patients who sustained brachial plexus injuries were examined and underwent surgery.

Shoulder Function Reconstruction in Brachial Plexus Birth Injury: Anterior Shoulder Release and Spinal Accessory to Suprascapular Nerve Transfer.

Purpose: This study evaluated the efficacy of the spinal accessory to suprascapular nerve transfer accompanied by anterior shoulder release in restoring shoulder external rotation and abduction in patients with brachial plexus birth injury.

Methods: A cohort of 41 children with brachial plexus birth injury and shoulder internal rotation contractures underwent surgical intervention. The procedure involved an anterior shoulder release encompassing subscapularis tenotomy, capsulotomy and division of the coracohumeral ligament, and transfer of the spinal accessory nerve to the suprascapular nerve.

Ten Myths in Nerve Surgery.

Background: Surgical innovation has provided new options for the management of complex peripheral nerve injuries, generating renewed interest in this field. Historic literature may be misinterpreted or misquoted, or create dogma, which is perpetuated in teaching, research publications, and clinical practice. The management of peripheral nerve injuries is based on complex decision-making, with potential lifelong ramifications for patients incorrectly receiving an expectant or surgical management plan.

Clinical Evidence of Retrograde Axonal Growth in Chronic Brachial Plexus Injury.

Nerve axons grow from proximal to distal after axonometric injury; however, they have been seen to regenerate via alternate routes, with some also demonstrating retrograde growth in neuromas. We present the case of a 33-year-old male with a 16-year-old traumatic brachial plexus injury presenting with neuropathic pain and isolated spontaneous recovery. Following a successful pre-operative anaesthetic block, a neurectomy of the median and ulnar nerves was planned for pain relief.

Extensor Carpi Radialis Brevis Tendon Transfer for Thumb and Finger Flexion Reconstruction after Failed Extensor Carpi Radialis Brevis Motor Branch Transfer in a Tetraplegic Patient.

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient.

Dorso Proximal Interphalangeal Island Flap.

Background: This study aimed to demonstrate the clinical application of the dorsoproximal interphalangeal island flap as an alternative approach to skin graft or cross-finger flap to repair lesions at the ventral site at the proximal interphalangeal (PIP) finger joint.

Methods: Fifteen patients received flaps (11 men and four women, n = 25 flaps). The repair of volar contracture in finger sequelae after burn injuries was the main indication.

Prevalence of Concomitant Distal Suprascapular Nerve Injury in Patients with Root-Level Brachial Plexus Palsy: A Clinical Anatomic Study of Injury Pattern.

Background: Root-level suprascapular nerve palsy is commonly reconstructed by means of spinal accessory nerve transfer in brachial plexus injury, but some patients do not recover. The authors hypothesize that this relates to concomitant undetected lesions distal to the nerve transfer coaptation.

Methods: A total of 67 patients with plexus injury and C5/C6 root involvement were included in this prospective study between March of 2021 and October of 2022.

Distal nerve transfers for peripheral nerve injuries: indications and outcomes.

Distal nerve transfer is a refined surgical technique involving the redirection of healthy sacrificable nerves from one part of the body to reinstate function in another area afflicted by paralysis or injury. This approach is particularly valuable when the original nerves are extensively damaged and standard repair methods, such as direct suturing or grafting, may be insufficient. As the nerve coaptation is close to the recipient muscles or skin, distal nerve transfers reduce the time to reinnervation.

Anconeus Muscle Transfer to Correct or Prevent Wrist Radial Deviation in Radial and Posterior Interosseous Nerve Injuries.

Purpose: Wrist radial deviation is a possible complication of tendon transfer for restoration of wrist extension in cases of radial nerve paralysis. In posterior interosseous nerve (PIN) injury, this is because of the imbalance caused by the intact extensor carpi radialis longus and paralysis of the extensor carpi ulnaris (ECU). This deformity may also occur following transfer of the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) for radial nerve palsy.

Complete tibial nerve lesion secondary to postoperative popliteal pseudoaneurysm following anterior cruciate ligament arthroscopic reconstruction: A series of two patients.

Background: Complications following arthroscopic anterior cruciate ligament reconstruction (ACLR) are rare, but injuries to the popliteal artery can occur. Popliteal pseudoaneurysms are a potential complication and can cause significant morbidity if not diagnosed and treated promptly.

Cases Description: We describe the cases of two patients who developed nerve injuries following arthroscopic ACLR, with subsequent diagnosis of a popliteal pseudoaneurysm.

A Fresh Cadaver Study on the Innervation of Brachioradialis and Extensor Carpi Radialis Longus Muscles.

Purpose: Distal nerve transfers have revolutionized peripheral nerve surgery by allowing the transfer of healthy motor nerves to paralyzed ones without causing additional morbidity. Radial nerve branches to the brachialis (Ba), brachioradialis (Br), and extensor carpi radialis longus (ECRL) muscles have not been investigated in fresh cadavers.

Methods: The radial nerve and its branches were dissected in 34 upper limbs from 17 fresh cadavers.

Long-Term Donor-Site Morbidity Following Entire Sural Nerve Harvest for Grafting.

Purpose: The sural nerve is the autologous nerve used most commonly for grafting. However, recent studies indicate a high rate of complications and complaints after sural nerve removal. In this prospective study, we evaluated donor-site morbidity following full-length sural nerve harvesting on long-term follow-up.

Pectoralis Major Reinnervation by Retrograde Nerve Regeneration after Complete Paralysis of the Brachial Plexus.

Spontaneous neuronal recovery is an expected phenomenon in brachial plexus palsy patients. However, the spontaneous recovery owing to retrograde regeneration is an evolving phenomenon with dearth of adequate research on it. Pectoralis major contraction on stimulation of median nerve (in the arm) is an unexpected phenomenon, in the absence of any anomalous communication and with distal coaptation site of intraplexal nerve repair.

Retrograde peripheral nerve regeneration from sensory to motor pathways in rats: a new experimental concept in nerve repair.

Background: The polarity of nerve grafts does not interfere with axon growth. Our goal was to investigate whether axons can regenerate in a retrograde fashion within sensory pathways and then extend into motor pathways, leading to muscle reinnervation.

Methods: Fifty-four rats were randomized into four groups.

Pulp-to-Pulp Pinch Reconstruction in a Tetraplegic Patient Utilizing Nerve and Tendon Transfers: A Case Report.

In tetraplegia, hand reconstruction is of high priority. Key pinch reconstruction has been advocated for tetraplegia hand reconstruction because of the lack of donors for nerve and tendon transfers. We report a patient with mid-cervical tetraplegia who underwent nerve and tendon transfers in the right and left upper limbs seven months post-injury to reconstruct hand function.

Reconstructing Pinch Strength after Ulnar Nerve Injury by Transferring the Opponens Pollicis Motor Branch.

Background: With ulnar nerve injuries, paralysis of the first dorsal interosseous and adductor pollicis muscle weakens the patient's pinch. In the palm, we transferred the opponens pollicis motor branch to the deep terminal division of the ulnar nerve for pinch reconstruction.

Methods: Sixteen patients with ulnar nerve injuries around the elbow underwent reconstruction and were followed up postoperatively for a minimum of 14 months.

Base of the Third Metacarpal as a Palpable and Reliable Landmark for Identifying the Median Nerve's Thenar Branch.

Purpose: The objective of this study was to investigate whether the base of the third metacarpal can predict the location of the thenar branch (TB) of the median nerve and the accuracy of palpating the base of the third metacarpal.

Methods: In 15 patients with ulnar nerve lesions around the elbow, we transferred the opponens motor branch to repair the deep terminal division of the ulnar nerve (DTDUN). Before surgery, we located the TB by palpating the base of the third metacarpal volarly.

Spinal Cord Injury: Epidemiology, Spontaneous Recovery, and Hand Therapy for the Reconstructive Hand Surgeon.

People with spinal cord injury (SCI) prioritize hand function above all else as a reconstructive goal, yet remain a markedly undertreated population by hand surgeons. This review article provides an overview of the epidemiology of SCI and the unmet clinical need of these patients. Further, this article outlines the natural history of SCI, including the expected spontaneous recovery over time and the expectations of hand function when treated with hand therapy alone.

Reverse Neurocutaneous Flap Based on the Dorsal Branch of the Ulnar Artery for Palm Coverage in Children: Long-Term Results.

Purpose: Although the palm is spared mostly in severe burn injuries, it often is affected in children and requires radical excision of contracting scar tissue to allow normal hand development. Since alternatives are limited for palmar coverage, we primarily use a reverse-perfused, neurocutaneous dorsal ulnar artery flap. We report here our long-term follow-up results.

A cut throat: a case of C5-C8 brachial plexus root transection providing evidence of T1 innervation of thumb and finger extensors.

The T1 nerve root is not routinely thought of as innervating the extensors of the thumb and fingers. Work by Bertelli and Ghizoni proposed that the pattern of brachial plexus paralysis with intact hand function and thumb and finger extensors traditionally attributed to C5/6/7 root injury is in fact a C5/6/7/8 injury, with only T1 remaining intact - a 'T1 hand'. This case presents a 19-year-old male who was stabbed in the neck; exploratory surgery determined complete transection of the brachial plexus, with only the T1 nerve root remaining intact.

Anatomy of Profunda Brachial Artery in the Axilla and Its Relationship With the Radial Nerve: Fresh-Cadaver Anatomical Study and Clinical Observations.

Purpose: Dissection of the radial nerve in the axilla and upper portion of and posterior aspect of arm may be necessary for brachial plexus reconstruction, in axillary nerve paralysis, and in radial nerve injuries. The radial nerve is in intimate contact with the profunda brachial artery (PBA). The authors sought to describe the relationship of the PBA with the radial nerve.

The Cutaneous Branches of the Median and Ulnar Nerves in the Palm.

Purpose: The dermatomal distributions of the ulnar and median nerves on the palmar skin of the hand have been studied thoroughly. However, the anatomic course of the median and ulnar cutaneous nerve branches and how they supply the skin of the palm is not well understood.

Methods: The cutaneous branches of the median and ulnar nerves were dissected bilaterally in 9 fresh cadavers injected arterially with green latex.

Bilateral Ulnar Nerve Injury in the Wrist: Comparison of First Webspace Muscle Reconstruction by Opponens Nerve Transfer in the Right Hand Versus Direct Ulnar Nerve Repair in the Left Hand.

We report a case of a bilateral glass injury to the wrist with transection of flexor tendons and the ulnar nerve and artery in a 60-year-old male patient. Two days after his accident, we repaired all divided structures, and on the right hand, we added the transfer of the opponens motor branch to the deep terminal division of the ulnar nerve aimed at first dorsal interosseous and adductor pollicis muscle reinnervation. After surgery, the patient was followed over 24 months.