Abstract
Purpose
Nerve transfers represent an innovative tool in the surgical treatment of upper limb paralysis. Well-documented for brachial plexus sequalae and under evaluation for tetraplegic patients, they have not yet been described for spastic upper limbs. The typical spastic deformity involves active and spastic flexor, adductor and pronator muscles, associated with paralysed extensor and supinator muscles. Experience with selective neurectomy has shown an effective decrease in spasticity together with preservation of muscle strength. We conceptualized a combination of neurectomy and nerve transfer, by performing a partial nerve transfer from a spastic elbow flexor muscle to a paralyzed wrist extensor muscle, hypothesizing that this would reduce the spasticity of the former and simultaneously activate the latter.
Methods
Ten cadaveric dissections were performed in order to establish the anatomic feasibility of transferring a motor branch of the brachioradialis (BR) onto the branch of the extensor carpi radialis longus (ECRL) or brevis (ECRB). We measured the emergence, length, muscle entry point and diameter of each branch, and attempted the transfer.
Results
We found 1–4 motor nerve for the BR muscle and 1–2 for the ECRL muscle. In all cases, the nerve transfer was achievable, allowing a satisfactory coaptation. The ECRB branch emerged too distally to be anastomosed to one of the BR branches.
Conclusion
This study shows that nerve transfers from the BR to the ECRL are anatomically feasible. It may open the way to an additional therapeutic approach for spastic upper limbs.
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Acknowledgements
Our thanks to the staff of the anatomy laboratory of the Ecole de Chirurgie du Fer à Moulin (Paris) for their precious help.
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The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received. The authors have no relevant financial or non-financial interests to disclose. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.
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CW: Data collection, dissections, manuscript writing and editing. SR: Help with dissections, ideas for project development. LM: Help with dissections, ideas for project development. CL: Protocol development, manuscript editing.
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Waxweiler, C., Remy, S., Merlini, L. et al. Nerve transfer in the spastic upper limb: anatomical feasibility study. Surg Radiol Anat 44, 183–190 (2022). https://doi.org/10.1007/s00276-021-02810-w
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DOI: https://doi.org/10.1007/s00276-021-02810-w