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Alexander Y. Shin - One of the best experts on this subject based on the ideXlab platform.
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free functioning gracilis muscle transfer versus Intercostal Nerve transfer to musculocutaneous Nerve for restoration of elbow flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:After complete five-level root brachial plexus injury, free functional muscle transfer and Intercostal Nerve transfer to the musculocutaneous Nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus Intercostal Nerve-to-musculocutaneous Nerve transfers with respect to strength.Sixty-two patients who underwent free functional muscle transfer reconstruction or Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores.In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the Intercostal Nerve-to-musculocutaneous Nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of Intercostal Nerves used for the musculocutaneous Nerve transfer did not correlate with better elbow flexion grade.Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction.Therapeutic, III.
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free functioning gracilis muscle transfer versus Intercostal Nerve transfer to musculocutaneous Nerve for restoration of elbow flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:BACKGROUND After complete five-level root brachial plexus injury, free functional muscle transfer and Intercostal Nerve transfer to the musculocutaneous Nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus Intercostal Nerve-to-musculocutaneous Nerve transfers with respect to strength. METHODS Sixty-two patients who underwent free functional muscle transfer reconstruction or Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores. RESULTS In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the Intercostal Nerve-to-musculocutaneous Nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of Intercostal Nerves used for the musculocutaneous Nerve transfer did not correlate with better elbow flexion grade. CONCLUSIONS Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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complications of Intercostal Nerve transfer for brachial plexus reconstruction
Journal of Hand Surgery (European Volume), 2010Co-Authors: Rudy Kovachevich, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Christina M Wood, Alexander Y. ShinAbstract:Purpose Although numerous publications discuss outcomes of Intercostal Nerve transfer for brachial plexus injury, few publications have addressed factors associated with Intercostal Nerve viability or the impact perioperative Nerve transfer complications have on postoperative Nerve function. The purposes of this study were to report the results of perioperative Intercostal Nerve transfer complications and to determine whether chest wall trauma is associated with damaged or nonviable Intercostal Nerves. Methods All patients who underwent Intercostal Nerve transfer as part of a brachial plexus reconstruction procedure as a result of injury were identified. A total of 459 Nerves in 153 patients were transferred between 1989 and 2007. Most Nerves were transferred for use in biceps innervation, free-functioning gracilis muscle innervation, or a combination of the two. Patient demographics, trauma mechanism, associated injuries, intraoperative Nerve viability, and perioperative complications were reviewed. Results Complications occurred in 23 of 153 patients. The most common complication was pleural tear during Nerve elevation, occurring in 14 of 153 patients. Superficial wound infection occurred in 3 patients, whereas symptomatic pleural effusion, acute respiratory distress syndrome, and seroma formation each occurred in 2 patients. The rate of complications increased with the number of Intercostal Nerves transferred. Nerves were harvested from previously fractured rib levels in 50 patients. Rib fractures were not associated with an increased risk of overall complications but were associated with an increased risk of lack of Nerve viability. In patients with rib fractures, intraoperative Nerve stimulation revealed 148 of 161 Nerves to be functional; these were subsequently transferred. In patients with preoperative ipsilateral phrenic Nerve palsy, the risk of increased complications was marginally significant. Conclusions Brachial plexus reconstruction using Intercostal Nerves can be challenging, especially if there is antecedent chest wall trauma. Complications were associated with increasing numbers of Intercostal Nerves transferred. Ipsilateral rib fracture was adversely associated with Intercostal Nerve viability; it was not significantly associated with complication risk and should not be considered a contraindication to transfer. Preoperative phrenic Nerve palsy was marginally associated with the likelihood of complications but not postoperative respiratory dysfunction when associated with Intercostal Nerve transfer. Type of study/level of evidence Therapeutic IV.
Vichai Vanadurongwan - One of the best experts on this subject based on the ideXlab platform.
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restoration of elbow flexion in brachial plexus avulsion injury comparing spinal accessory Nerve transfer with Intercostal Nerve transfer
Journal of Hand Surgery (European Volume), 1999Co-Authors: Saranatra Waikakul, Saichol Wongtragul, Vichai VanadurongwanAbstract:This study was performed to compare the clinical outcome of 2 types of commonly used Nerve transfers, the spinal accessory Nerve transfer and the Intercostal Nerve transfer. This study was a prospective randomized parallel trial involving 205 patients presenting between 1989 and 1994. All patients were males ranging in age from 16 to 43 years. All patients underwent surgery within 6 months of injury. Spinal accessory Nerve transfer was performed in 130 patients; better results were obtained in terms of less operative time, fewer blood transfusions, fewer immediate complications, and better motor function (very good and good power in 83% of patients). Intercostal Nerve transfer was performed in 75 patients; better results were observed in terms of earlier electromyographic evidence of motor reinnervation, improvement in protective sensation, and reduction of pain. However, very good and good motor recovery was observed in only 64% of patients. There was no significant difference with regard to tidal volume, vital capacity, and the FEV1 to FEV ratio before and after surgery in either group. Smoking adversely affected the rate of recovery. Spinal accessory Nerve transfer should be used when motor function of the elbow flexors is the major concern. Intercostal Nerve transfer should be performed in patients who need both motor and sensory reconstruction and in those who have chronic pain syndrome after brachial plexus injury.
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restoration of elbow flexion in branchial plexus avulsion injury comparing spinal accessory Nerve transfer with Intercostal Nerve transfer
Journal of Hand Surgery (European Volume), 1999Co-Authors: Saranatra Waikakul, Saichol Wongtragul, Vichai VanadurongwanAbstract:Abstract This study was performed to compare the clinical outcome of 2 types of commonly used Nerve transfers, the spinal accessory Nerve transfer and the Intercostal Nerve transfer. This study was a prospective randomized parallel trial involving 205 patients presenting between 1989 and 1994. All patients were males ranging in age from 16 to 43 years. All patients underwent surgery within 6 months of injury. Spinal accessory Nerve transfer was performed in 130 patients; better results were obtained in terms of less operative time, fewer blood transfusions, fewer immediate complications, and better motor function (very good and good power in 83% of patients). Intercostal Nerve transfer was performed in 75 patients; better results were observed in terms of earlier electromyographic evidence of motor reinnervation, improvement in protective sensation, and reduction of pain. However, very good and good motor recovery was observed in only 64% of patients. There was no significant difference with regard to tidal volume, vital capacity, and the FEV 1 to FEV ratio before and after surgery in either group. Smoking adversely affected the rate of recovery. Spinal accessory Nerve transfer should be used when motor function of the elbow flexors is the major concern. Intercostal Nerve transfer should be performed in patients who need both motor and sensory reconstruction and in those who have chronic pain syndrome after brachial plexus injury. (J Hand Surg 1999;24A:571–577. Copyright © 1999 by the American Society for Surgery of the Hand.)
Allen T. Bishop - One of the best experts on this subject based on the ideXlab platform.
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free functioning gracilis muscle transfer versus Intercostal Nerve transfer to musculocutaneous Nerve for restoration of elbow flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:After complete five-level root brachial plexus injury, free functional muscle transfer and Intercostal Nerve transfer to the musculocutaneous Nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus Intercostal Nerve-to-musculocutaneous Nerve transfers with respect to strength.Sixty-two patients who underwent free functional muscle transfer reconstruction or Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores.In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the Intercostal Nerve-to-musculocutaneous Nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of Intercostal Nerves used for the musculocutaneous Nerve transfer did not correlate with better elbow flexion grade.Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction.Therapeutic, III.
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free functioning gracilis muscle transfer versus Intercostal Nerve transfer to musculocutaneous Nerve for restoration of elbow flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:BACKGROUND After complete five-level root brachial plexus injury, free functional muscle transfer and Intercostal Nerve transfer to the musculocutaneous Nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus Intercostal Nerve-to-musculocutaneous Nerve transfers with respect to strength. METHODS Sixty-two patients who underwent free functional muscle transfer reconstruction or Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores. RESULTS In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the Intercostal Nerve-to-musculocutaneous Nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of Intercostal Nerves used for the musculocutaneous Nerve transfer did not correlate with better elbow flexion grade. CONCLUSIONS Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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complications of Intercostal Nerve transfer for brachial plexus reconstruction
Journal of Hand Surgery (European Volume), 2010Co-Authors: Rudy Kovachevich, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Christina M Wood, Alexander Y. ShinAbstract:Purpose Although numerous publications discuss outcomes of Intercostal Nerve transfer for brachial plexus injury, few publications have addressed factors associated with Intercostal Nerve viability or the impact perioperative Nerve transfer complications have on postoperative Nerve function. The purposes of this study were to report the results of perioperative Intercostal Nerve transfer complications and to determine whether chest wall trauma is associated with damaged or nonviable Intercostal Nerves. Methods All patients who underwent Intercostal Nerve transfer as part of a brachial plexus reconstruction procedure as a result of injury were identified. A total of 459 Nerves in 153 patients were transferred between 1989 and 2007. Most Nerves were transferred for use in biceps innervation, free-functioning gracilis muscle innervation, or a combination of the two. Patient demographics, trauma mechanism, associated injuries, intraoperative Nerve viability, and perioperative complications were reviewed. Results Complications occurred in 23 of 153 patients. The most common complication was pleural tear during Nerve elevation, occurring in 14 of 153 patients. Superficial wound infection occurred in 3 patients, whereas symptomatic pleural effusion, acute respiratory distress syndrome, and seroma formation each occurred in 2 patients. The rate of complications increased with the number of Intercostal Nerves transferred. Nerves were harvested from previously fractured rib levels in 50 patients. Rib fractures were not associated with an increased risk of overall complications but were associated with an increased risk of lack of Nerve viability. In patients with rib fractures, intraoperative Nerve stimulation revealed 148 of 161 Nerves to be functional; these were subsequently transferred. In patients with preoperative ipsilateral phrenic Nerve palsy, the risk of increased complications was marginally significant. Conclusions Brachial plexus reconstruction using Intercostal Nerves can be challenging, especially if there is antecedent chest wall trauma. Complications were associated with increasing numbers of Intercostal Nerves transferred. Ipsilateral rib fracture was adversely associated with Intercostal Nerve viability; it was not significantly associated with complication risk and should not be considered a contraindication to transfer. Preoperative phrenic Nerve palsy was marginally associated with the likelihood of complications but not postoperative respiratory dysfunction when associated with Intercostal Nerve transfer. Type of study/level of evidence Therapeutic IV.
Robert J. Spinner - One of the best experts on this subject based on the ideXlab platform.
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free functioning gracilis muscle transfer versus Intercostal Nerve transfer to musculocutaneous Nerve for restoration of elbow flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:After complete five-level root brachial plexus injury, free functional muscle transfer and Intercostal Nerve transfer to the musculocutaneous Nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus Intercostal Nerve-to-musculocutaneous Nerve transfers with respect to strength.Sixty-two patients who underwent free functional muscle transfer reconstruction or Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores.In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the Intercostal Nerve-to-musculocutaneous Nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of Intercostal Nerves used for the musculocutaneous Nerve transfer did not correlate with better elbow flexion grade.Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction.Therapeutic, III.
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free functioning gracilis muscle transfer versus Intercostal Nerve transfer to musculocutaneous Nerve for restoration of elbow flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:BACKGROUND After complete five-level root brachial plexus injury, free functional muscle transfer and Intercostal Nerve transfer to the musculocutaneous Nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus Intercostal Nerve-to-musculocutaneous Nerve transfers with respect to strength. METHODS Sixty-two patients who underwent free functional muscle transfer reconstruction or Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores. RESULTS In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the Intercostal Nerve-to-musculocutaneous Nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of Intercostal Nerves used for the musculocutaneous Nerve transfer did not correlate with better elbow flexion grade. CONCLUSIONS Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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complications of Intercostal Nerve transfer for brachial plexus reconstruction
Journal of Hand Surgery (European Volume), 2010Co-Authors: Rudy Kovachevich, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Christina M Wood, Alexander Y. ShinAbstract:Purpose Although numerous publications discuss outcomes of Intercostal Nerve transfer for brachial plexus injury, few publications have addressed factors associated with Intercostal Nerve viability or the impact perioperative Nerve transfer complications have on postoperative Nerve function. The purposes of this study were to report the results of perioperative Intercostal Nerve transfer complications and to determine whether chest wall trauma is associated with damaged or nonviable Intercostal Nerves. Methods All patients who underwent Intercostal Nerve transfer as part of a brachial plexus reconstruction procedure as a result of injury were identified. A total of 459 Nerves in 153 patients were transferred between 1989 and 2007. Most Nerves were transferred for use in biceps innervation, free-functioning gracilis muscle innervation, or a combination of the two. Patient demographics, trauma mechanism, associated injuries, intraoperative Nerve viability, and perioperative complications were reviewed. Results Complications occurred in 23 of 153 patients. The most common complication was pleural tear during Nerve elevation, occurring in 14 of 153 patients. Superficial wound infection occurred in 3 patients, whereas symptomatic pleural effusion, acute respiratory distress syndrome, and seroma formation each occurred in 2 patients. The rate of complications increased with the number of Intercostal Nerves transferred. Nerves were harvested from previously fractured rib levels in 50 patients. Rib fractures were not associated with an increased risk of overall complications but were associated with an increased risk of lack of Nerve viability. In patients with rib fractures, intraoperative Nerve stimulation revealed 148 of 161 Nerves to be functional; these were subsequently transferred. In patients with preoperative ipsilateral phrenic Nerve palsy, the risk of increased complications was marginally significant. Conclusions Brachial plexus reconstruction using Intercostal Nerves can be challenging, especially if there is antecedent chest wall trauma. Complications were associated with increasing numbers of Intercostal Nerves transferred. Ipsilateral rib fracture was adversely associated with Intercostal Nerve viability; it was not significantly associated with complication risk and should not be considered a contraindication to transfer. Preoperative phrenic Nerve palsy was marginally associated with the likelihood of complications but not postoperative respiratory dysfunction when associated with Intercostal Nerve transfer. Type of study/level of evidence Therapeutic IV.
Michelle F. Kircher - One of the best experts on this subject based on the ideXlab platform.
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free functioning gracilis muscle transfer versus Intercostal Nerve transfer to musculocutaneous Nerve for restoration of elbow flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:After complete five-level root brachial plexus injury, free functional muscle transfer and Intercostal Nerve transfer to the musculocutaneous Nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus Intercostal Nerve-to-musculocutaneous Nerve transfers with respect to strength.Sixty-two patients who underwent free functional muscle transfer reconstruction or Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores.In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the Intercostal Nerve-to-musculocutaneous Nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of Intercostal Nerves used for the musculocutaneous Nerve transfer did not correlate with better elbow flexion grade.Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction.Therapeutic, III.
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free functioning gracilis muscle transfer versus Intercostal Nerve transfer to musculocutaneous Nerve for restoration of elbow flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:BACKGROUND After complete five-level root brachial plexus injury, free functional muscle transfer and Intercostal Nerve transfer to the musculocutaneous Nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus Intercostal Nerve-to-musculocutaneous Nerve transfers with respect to strength. METHODS Sixty-two patients who underwent free functional muscle transfer reconstruction or Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores. RESULTS In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the Intercostal Nerve-to-musculocutaneous Nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of Intercostal Nerves used for the musculocutaneous Nerve transfer did not correlate with better elbow flexion grade. CONCLUSIONS Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than Intercostal Nerve-to-musculocutaneous Nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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complications of Intercostal Nerve transfer for brachial plexus reconstruction
Journal of Hand Surgery (European Volume), 2010Co-Authors: Rudy Kovachevich, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Christina M Wood, Alexander Y. ShinAbstract:Purpose Although numerous publications discuss outcomes of Intercostal Nerve transfer for brachial plexus injury, few publications have addressed factors associated with Intercostal Nerve viability or the impact perioperative Nerve transfer complications have on postoperative Nerve function. The purposes of this study were to report the results of perioperative Intercostal Nerve transfer complications and to determine whether chest wall trauma is associated with damaged or nonviable Intercostal Nerves. Methods All patients who underwent Intercostal Nerve transfer as part of a brachial plexus reconstruction procedure as a result of injury were identified. A total of 459 Nerves in 153 patients were transferred between 1989 and 2007. Most Nerves were transferred for use in biceps innervation, free-functioning gracilis muscle innervation, or a combination of the two. Patient demographics, trauma mechanism, associated injuries, intraoperative Nerve viability, and perioperative complications were reviewed. Results Complications occurred in 23 of 153 patients. The most common complication was pleural tear during Nerve elevation, occurring in 14 of 153 patients. Superficial wound infection occurred in 3 patients, whereas symptomatic pleural effusion, acute respiratory distress syndrome, and seroma formation each occurred in 2 patients. The rate of complications increased with the number of Intercostal Nerves transferred. Nerves were harvested from previously fractured rib levels in 50 patients. Rib fractures were not associated with an increased risk of overall complications but were associated with an increased risk of lack of Nerve viability. In patients with rib fractures, intraoperative Nerve stimulation revealed 148 of 161 Nerves to be functional; these were subsequently transferred. In patients with preoperative ipsilateral phrenic Nerve palsy, the risk of increased complications was marginally significant. Conclusions Brachial plexus reconstruction using Intercostal Nerves can be challenging, especially if there is antecedent chest wall trauma. Complications were associated with increasing numbers of Intercostal Nerves transferred. Ipsilateral rib fracture was adversely associated with Intercostal Nerve viability; it was not significantly associated with complication risk and should not be considered a contraindication to transfer. Preoperative phrenic Nerve palsy was marginally associated with the likelihood of complications but not postoperative respiratory dysfunction when associated with Intercostal Nerve transfer. Type of study/level of evidence Therapeutic IV.