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Medial pectoral nerve to axillary nerve neurotization following traumatic brachial plexus injuries: indications and clinical outcomes

  • Surgery Articles
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HAND

Abstract

Introduction

The medial pectoral nerve (MPN) represents a viable donor nerve for neurotization procedures for restoration of shoulder function following upper trunk brachial plexus injuries.

Materials and Methods

We report an eight-case series, single-surgeon experience of patients with upper trunk brachial plexus injuries who underwent MPN to axillary nerve (AXN) transfer from 2001–2007 for shoulder stability and abduction.

Results

The mean patient age was 31.5 (range, 19–51 years). The mean follow-up for all patients was 22.25 ± 7.4 months. Surgery was performed at a mean of 5.8 ± 2.9 months post-injury. On initial evaluation, all eight patients had no deltoid function (M0). Of the eight patients examined postoperatively, we observed excellent recovery in four, good recovery in two, fair recovery in one, and poor functional recovery in the remaining patient.

Discussion

MPN to AXN neurotization is a valid surgical option in the restoration of shoulder stability and shoulder abduction following trauma-related upper trunk brachial plexus injury.

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References

  1. Blaauw G, Slooff ACJ. Transfer of pectoral nerves to the musculocutaneous nerve in obstetric upper brachial plexus palsy. Neurosurgery. 2003;53:338–42. doi:310.1227/1201.NEU.0000073420.0000066113.0000073466.

    Article  PubMed  Google Scholar 

  2. Chuang DC, Lee GW, Hashem F, Wei FC. Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg. 1995;96:122–8.

    Article  PubMed  CAS  Google Scholar 

  3. Colbert S, Mackinnon S. Posterior approach for double nerve transfer for restoration of shoulder function in upper brachial plexus palsy. Hand. 2006;1:71–7.

    Article  PubMed  Google Scholar 

  4. Colbert SH, Mackinnon SE. Nerve transfers for brachial plexus reconstruction. Hand Clin. 2008;24:341–61.

    Article  PubMed  Google Scholar 

  5. Compston A. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. His Majesty's Stationery Office: 1942; pp. 48 (iii) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. By Michael O'Brien for the Guarantors of Brain. Saunders Elsevier: 2010; pp. [8] 64 and 94 Figures. Brain. 2010;133:2838–44.

    Article  PubMed  Google Scholar 

  6. Elsberg CA. Experiments on motor nerve regeneration and the direct neurotization of paralyzed muscles by their own and by foreign nerves. Science. 1917;45:318–20.

    Article  PubMed  CAS  Google Scholar 

  7. Hansasuta A, Tubbs RS, Grabb PA. Surgical relationship of the medial pectoral nerve to the musculocutaneous nerve: a cadaveric study. Neurosurgery. 2001;48:203–7.

    PubMed  CAS  Google Scholar 

  8. Hosseinian MA, Tofigh AM. Cross pectoral nerve transfer following free gracilis muscle transplantation for chronic brachial plexus palsy: a case series. Int J Surg. 2008;6:125–8.

    Article  PubMed  Google Scholar 

  9. Humphreys DB, Mackinnon SE. Nerve transfers. Oper Tech Plast Reconstr Surg. 2002;9:89–99.

    Article  Google Scholar 

  10. Lee K-S. Anatomic variation of the spinal origins of lateral and medial pectoral nerves. Clin Anat. 2007;20:915–8.

    Article  PubMed  Google Scholar 

  11. Lurje A. Concerning surgical treatment of traumatic injury to the upper division of the brachial plexus (Erb's type). Ann Surg. 1948;127:317–26.

    Article  Google Scholar 

  12. Macchi V, Tiengo C, Porzionato A, Parenti A, Stecco C, Mazzoleni F, et al. Medial and lateral pectoral nerves: course and branches. Clin Anat. 2007;20:157–62.

    Article  PubMed  Google Scholar 

  13. Mackinnon SE. Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies. Plast Reconstr Surg. 2006;118:1273. doi:1210.1097/1201.prs.0000238220.0000256097.0000238224e.

    Article  PubMed  CAS  Google Scholar 

  14. Midha R. Epidemiology of brachial plexus injuries in a multitrauma population. Neurosurgery. 1997;40:1182–9.

    Article  PubMed  CAS  Google Scholar 

  15. Midha R. Nerve transfers for severe brachial plexus injuries: a review. Neurosurg Focus. 2004;16:E5.

    Article  PubMed  Google Scholar 

  16. Novak CB, Mackinnon SE. Treatment of a proximal accessory nerve injury with nerve transfer. Laryngoscope. 2004;114:1482–4.

    Article  PubMed  Google Scholar 

  17. Park TS. Medial pectoral nerve transfer. J Neurosurg Pediatr. 2009;3:345–6.

    Article  PubMed  Google Scholar 

  18. Samardzic M, Grujicic D, Antunovic V. Nerve transfer in brachial plexus traction injuries. J Neurosurg. 1992;76:191–7.

    Article  PubMed  CAS  Google Scholar 

  19. Samardzic M, Grujicic D, Rasulic L, Bacetic D. Transfer of the medial pectoral nerve: myth or reality? Neurosurgery. 2002;50:1277–82.

    PubMed  Google Scholar 

  20. Shin AY, Spinner RJ, Bishop AT. Nerve transfers for brachial plexus injuries. Oper Tech Orthopaedics 2004;14(3)199–212

    Google Scholar 

  21. Terzis JK, Kostas I. Suprascapular nerve reconstruction in 118 cases of adult posttraumatic brachial plexus. Plast Reconstr Surg. 2006;117:613–29. doi:610.1097/1001.prs.0000203410.0000235395.fa.

    Article  PubMed  CAS  Google Scholar 

  22. Terzis JK, Kostas I, Soucacos PN. Restoration of shoulder function with nerve transfers in traumatic brachial plexus palsy patients. Microsurgery. 2006;26:316–24.

    Article  PubMed  Google Scholar 

  23. Terzis JK, Kostopoulos VK. The surgical treatment of brachial plexus injuries in adults. Plast Reconstr Surg. 2007;119:73e–92e. doi:10.1097/1001.prs.0000254859.0000251903.0000254897.

    Article  PubMed  Google Scholar 

  24. Tomaino MM. Neurophysiologic and clinical outcome following medial pectoral to long thoracic nerve transfer for scapular winging: a case report. Microsurgery. 2002;22:254–7.

    Article  PubMed  Google Scholar 

  25. Tung TH, Mackinnon SE. Brachial plexus injuries. Clin Plast Surg. 2003;30:269–87.

    Article  PubMed  Google Scholar 

  26. Tuttle H. Exposure of the brachial plexus with nerve transplantation. JAMA. 1913;61:15–7.

    Article  Google Scholar 

  27. Wellons JC, Tubbs RS, Pugh JA, Bradley NJ, Law CR, Grabb PA. Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. J Neurosurg Pediatr. 2009;3:348–53.

    Article  PubMed  Google Scholar 

  28. Wellons JC, Tubbs RS, Pugh JA, Bradley NJ, Law CR, Grabb PA. Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. J Neurosurg: Ped. 2009;3:348–53.

    Article  Google Scholar 

  29. Witoonchart K, Leechavengvongs S, Uerpairojkit C, Thuvasethakul P, Wongnopsuwan V. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: an anatomic feasibility study. J Hand Surg. 2003;28:628–32.

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank Tina Orth, RN, for her invaluable help in the data collection process for the patients included in this manuscript.

This study is not funded by grant support.

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified.

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Authors and Affiliations

  1. Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Wilson Z. Ray & Rory K. J. Murphy

  2. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Katherine Santosa, Philip J. Johnson & Susan E. Mackinnon

Authors
  1. Wilson Z. Ray
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  2. Rory K. J. Murphy
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  3. Katherine Santosa
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  4. Philip J. Johnson
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  5. Susan E. Mackinnon
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Corresponding author

Correspondence to Susan E. Mackinnon.

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Ray, W.Z., Murphy, R.K.J., Santosa, K. et al. Medial pectoral nerve to axillary nerve neurotization following traumatic brachial plexus injuries: indications and clinical outcomes. HAND 7, 59–65 (2012). https://doi.org/10.1007/s11552-011-9378-9

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