Reparación aguda de lesión traumática del plexo pan-braquial: consideraciones técnicas y abordajes

Acute repair of traumatic pan-brachial plexus injury: technical considerations and approaches

 

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29291296

http://thejns.org/doi/10.3171/2018.1.FocusVid.17569

 

De:

Abou-Al-Shaar H1, Karsy M1, Ravindra V1, Joyce E1, Mahan MA1.

2018 Jan;44(VideoSuppl1):V4. doi: 10.3171/2018.1.FocusVid.17569.

 

Todos los derechos reservados para:

© Copyright 1944-2017 American Association of Neurological Surgeons

 

Abstract

Particularly challenging after complete brachial plexus avulsion is reestablishing effective hand function, due to limited neurological donors to reanimate the arm. Acute repair of avulsion injuries may enable reinnervation strategies for achieving hand function. This patient presented with pan-brachial plexus injury. Given its irreparable nature, the authors recommended multistage reconstruction, including contralateral C-7 transfer for hand function, multiple intercostal nerves for shoulder/triceps function, shoulder fusion, and spinal accessory nerve-to-musculocutaneous nerve transfer for elbow flexion. The video demonstrates distal contraction from electrical stimulation of the avulsed roots. Single neurorrhaphy of the contralateral C-7 transfer was performed along with a retrosternocleidomastoid approach. The video can be found here: https://youtu.be/GMPfno8sK0U .

KEYWORDS:

C-7 nerve transfer; avulsion; neurorrhaphy; pan–brachial plexus injury; video

 

 

Resumen

Particularmente desafiante después de la avulsión completa del plexo braquial está restableciendo la función de la mano efectiva, debido a los donantes neurológicos limitados para reanimar el brazo. La reparación aguda de lesiones por avulsión puede permitir estrategias de reinervación para lograr la función de la mano. Este paciente presentó una lesión del plexo pan-braquial. Dada su naturaleza irreparable, los autores recomendaron la reconstrucción de múltiples etapas, incluida la transferencia C-7 contralateral para la función de la mano, múltiples nervios intercostales para la función hombro / tríceps, fusión de hombro y la transferencia nerviosa espinal-musculocutánea espinal para la flexión del codo. El video muestra la contracción distal de la estimulación eléctrica de las raíces avulsionadas. La neurorrafia simple de la transferencia contralateral C-7 se realizó junto con un abordaje retrosternocleidomastoideo.

El video se puede encontrar aquí:

https://youtu.be/GMPfno8sK0U

PALABRAS CLAVE:
Transferencia nerviosa C-7; avulsión; neurorrafia; lesión del plexo pan-braquial; vídeo

PMID:  29291296  DOI:  10.3171/2018.1.FocusVid.17569

Brachialis to Anterior Interosseous Nerve Transfer with Extended Forearm Incision – Standard

Fuente
Este artículo es originalmente publicado en:

 

https://youtu.be/bPzOwtA8Hww

 

 

De y Todos los derechos reservados para:

 

Courtesy : Authors: Susan E. Mackinnon, Andrew Yee Affiliation: Washington University School of Medicine Division of Plastic Reconstructive Surgery Department of Surgery Saint Louis, MO Peripheral Nerve Surgery: http://nervesurgery.wustl.edu
Brachialis to Anterior Interosseous Nerve Transfer with Extended Forearm Incision
Standard Edition (140312.140314)

 

 

Loss of flexor pollicis longus and radial profundus function results in a deficit of pinch and reduced grip strength in the hand. This palsy can be isolated or commonly included in a lower brachial plexus injury. The brachialis nerve is an available, synergistic, and powerful donor for transfer in these scenarios, especially in C7,8,T1 injuries and when other common donors are unavailable due to injury like the extensor carpi radialis brevis. In this case, the patient presented three months following a partial C7 and C8,T1 brachial plexus injury from a fall with no recovery on electrodiagnostic studies. The brachialis to anterior interosseous nerve transfer was elected with the supinator to flexor digitorum superficialis nerve transfer and lateral antebrachial cutaneous to ulnar sensory nerve transfer. This video details the specifics for the brachialis transfer with an extended incision into the forearm to confirm the proximal topography of the anterior interosseous fascicle in the median nerve. Additionally, this patient has an anomalous sensory nerve anastomosis from a brachialis nerve branch to the sensory component of the median nerve.

Tables of Contents (Standard)
00:57 Proximal Arm Exposure
01:51 Exposure and Identification of Median Nerve in the Arm
03:18 Exposure and Identification of Musculocutaneous Nerve and Brachialis Branch
04:41 Neurolysis of Median Nerve to Identify the Pronator Teres and AIN Fascicles
07:38 Distal Forearm Exposure
08:34 Step-lengthening the Pronator Teres for Proximal Median Nerve Exposure
10:36 Exposure of Median Nerve in the Forearm
11:05 Identifying the Distal Pronator Teres Branch
12:20 Identifying the Proximal Pronator Teres Branch and Proximal Neurolysis
12:52 Exposure of Anterior Interosseous Nerve Branch
14:16 Extension of Proximal Arm Exposure
14:58 Fascicular Course of the Anterior Interosseous Nerve from Distal to Proximal
16:42 Dissection and Distal Division of Donor Brachialis Nerve Branch
17:27 Anomalous Sensory Anastomosis from Brachialis Nerve Branch to Median Nerve
18:25 Neurolysis and Proximal Division of Recipient Anterior Interosseous Fascicle
19:42 Brachialis to Anterior Interosseous Nerve Transfer

Narration: Susan E. Mackinnon
Videography: Andrew Yee