The Experts below are selected from a list of 129 Experts worldwide ranked by ideXlab platform
Paul A Grabb - One of the best experts on this subject based on the ideXlab platform.
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Medial Pectoral Nerve to musculocutaneous Nerve neurotization for the treatment of persistent birth related brachial plexus palsy an 11 year institutional experience
Journal of Neurosurgery, 2009Co-Authors: John C Wellons, Shane R Tubbs, Jeffrey Pugh, Nadine Bradley, Charles R Law, Paul A GrabbAbstract:Object Medial Pectoral Nerve (MPN) to musculocutaneous Nerve (MCN) neurotization for recovery of elbow flexion by biceps reinnervation is a valid option following traumatic injury to the upper brachial plexus. A major criticism of the application of this technique in infants is the smaller size of the MPN and mismatch of viable axons. We describe our institutional experience utilizing this procedure and critically examine functional outcomes. Methods Office charts and hospital records of children from over an 11-year period beginning January 1997 were reviewed. Of the 53 children of various ages undergoing brachial plexus exploration for traumatic injury of any nature, 20 underwent MPN to MCN neurotization as a part of an overall procedure in the first year of life to treat birth-related brachial plexus palsy and had at least 9 months' follow-up. Medial Pectoral Nerve to MCN neurotization was chosen if the results of clinical examination and intraoperative electrophysiological evidence were consistent wit...
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surgical relationship of the Medial Pectoral Nerve to the musculocutaneous Nerve a cadaveric study
Neurosurgery, 2001Co-Authors: A Hansasuta, Rs Tubbs, Paul A GrabbAbstract:OBJECTIVE: For purposes of neurotization of the musculocutaneous Nerve (MCN) with the Medial Pectoral Nerve (MPN) after upper trunk brachial plexus injuries, the anatomic relationship between these two Nerves was defined in a cadaveric model. METHODS: Thirty-five brachial plexuses in 18 adult cadavers were dissected. The distance between the origin of the MPN from the Medial cord to the origin of the MCN from the lateral cord was measured. The length, diameter, branching, and location of the MPN were recorded. The diameter of the proximal MCN was recorded. RESULTS: Thirty-seven percent of the MPNs, when detached from the Pectoralis muscles, were too short to reach the proximal MCN by a mean distance of 15 mm. The MPN pierced the Pectoralis minor muscle in 80% of the dissections. The cross sectional area of the MCN was always larger than the cross sectional area of the MPN by an average factor of 2.5. CONCLUSION: When planning to use the MPN for neurotization of the MCN, one should be prepared to harvest an interposition graft, because over one-third of MPNs may not have enough length to reach the MCN in a tension-free manner. Diameter mismatch occurs predictably between the distal MPN and the proximal MCN.
Susan E Mackinnon - One of the best experts on this subject based on the ideXlab platform.
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Medial Pectoral Nerve to axillary Nerve neurotization following traumatic brachial plexus injuries indications and clinical outcomes
Hand, 2012Co-Authors: Rory K J Murphy, Katherine B Santosa, Philip J Johnson, Susan E MackinnonAbstract: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.
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Medial Pectoral Nerve to axillary Nerve neurotization following traumatic brachial plexus injuries: indications and clinical outcomes
HAND, 2012Co-Authors: Wilson Z. Ray, Rory K J Murphy, Philip J Johnson, Katherine Santosa, Susan E MackinnonAbstract: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.
Abdolreza Rouientan - One of the best experts on this subject based on the ideXlab platform.
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contralateral Medial Pectoral Nerve transfer with free gracilis muscle transfer in old brachial plexus palsy
Journal of Surgical Research, 2018Co-Authors: Masoud Yavari, Hormoz Mahmoudvand, Sedigheh Nadri, Abdolreza RouientanAbstract:Abstract Background There is a very small chance of success for Nerve reconstruction in patients with old total brachial plexus palsy who visit after 2 y or suffer from flail upper extremity after the failure of previous operations. Materials and methods For these individuals, the surgeon has to find a recipient motor Nerve to perform free gracilis muscle transplantation. In this study, contralateral Medial Pectoral Nerve from the intact side was transferred to the damaged side as a recipient Nerve. Then, in the second operation, approximately 15 mo later, the free gracilis muscle transfer was performed. The gracilis muscle was removed and transferred to provide elbow and finger flexion. Results In a retrospective study (over 10 y), we reviewed 68 patients for whom this method had been performed. After 1 y, the results were investigated using the Medical Research Council grading system. Five patients did not participate in the study, and the muscle underwent necrosis in two patients. M3 and M4 muscle power was regained in 26 (42.6%) and 21 (34.4%) patients, respectively. Conclusions Contralateral Pectoral Nerve transfer followed by free muscle transplantation can be a good option for patients with old total brachial plexus palsy.
Cabello César - One of the best experts on this subject based on the ideXlab platform.
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Randomized Clinical Trial On The Preservation Of The Medial Pectoral Nerve Following Mastectomy Due To Breast Cancer: Impact On Upper Limb Rehabilitation.
2015Co-Authors: Gonçalves, Andrea De Vasconcelos, Teixeira, Luiz Carlos, Torresan Renato, Alvarenga César, Cabello CésarAbstract:Systematic modifications to the surgical technique of mastectomy have been proposed with the objective of minimizing injuries to the Pectoral Nerves and their effects. The aim of this study was to compare muscle strength and mass of the Pectoralis major muscle (PMM) and abduction and flexion of the homolateral upper limb following mastectomy among women with breast cancer undergoing either preservation or sectioning of the Medial Pectoral Nerve (MPN). Randomized, double-blind, clinical trial on 30 women with breast cancer who underwent mastectomy between July 2002 and May 2003 in Campinas, Brazil. The women were allocated to a group, in which the MPN was preserved, or to another group in which it was sectioned. Fisher's exact and Wilcoxon tests were used to analyze the data, along with Friedman and ANOVA analysis of variance. In the MPN preserved group, 81% of the women did not lose any PMM strength, compared with 31% in the sectioned MPN group (confidence interval, CI = 1.21; relative risk, RR = 2.14; P < 0.03). There were no differences between the groups regarding muscle mass (CI = 0.32; RR = 0.89; P = 0.8), shoulder abduction (CI = 1.36; RR = 0.89; P = 0.28) and shoulder flexion (CI = 1.36; RR = 1.93; P = 0.8). Preservation of the MPN was significantly associated with maintenance of PMM strength, compared with Nerve sectioning. No differences in muscle mass or in abduction and flexion of the homolateral shoulder were found between the groups. ANZCTR - 00082622
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Estudo clínico aleatório sobre a preservação do nervo peitoral Medial em mastectomia por câncer de mama: impacto na reabilitação do membro superior
Associação Paulista de Medicina - APM, 2015Co-Authors: Gonçalves, Andrea De Vasconcelos, Teixeira, Luiz Carlos, Torresan Renato, Alvarenga César, Cabello CésarAbstract:CONTEXT AND OBJECTIVE: Systematic modifications to the surgical technique of mastectomy have been proposed with the objective of minimizing injuries to the Pectoral Nerves and their effects. The aim of this study was to compare muscle strength and mass of the Pectoralis major muscle (PMM) and abduction and flexion of the homolateral upper limb following mastectomy among women with breast cancer undergoing either preservation or sectioning of the Medial Pectoral Nerve (MPN). DESIGN AND SETTING: Randomized, double-blind, clinical trial on 30 women with breast cancer who underwent mastectomy between July 2002 and May 2003 in Campinas, Brazil. METHODS: The women were allocated to a group, in which the MPN was preserved, or to another group in which it was sectioned. Fisher's exact and Wilcoxon tests were used to analyze the data, along with Friedman and ANOVA analysis of variance. RESULTS: In the MPN preserved group, 81% of the women did not lose any PMM strength, compared with 31% in the sectioned MPN group (confidence interval, CI = 1.21; relative risk, RR = 2.14; P < 0.03). There were no differences between the groups regarding muscle mass (CI = 0.32; RR = 0.89; P = 0.8), shoulder abduction (CI = 1.36; RR = 0.89; P = 0.28) and shoulder flexion (CI = 1.36; RR = 1.93; P = 0.8). CONCLUSIONS: Preservation of the MPN was significantly associated with maintenance of PMM strength, compared with Nerve sectioning. No differences in muscle mass or in abduction and flexion of the homolateral shoulder were found between the groups.CONTEXTO E OBJETIVO: Modificações sistemáticas técnica cirúrgica das mastectomias têm sido propostas com o objetivo de minimizar lesões dos nervos peitorais e seus efeitos. O objetivo deste artigo foi comparar força e trofismo do músculo peitoral maior (MPM) e amplitude de movimento do membro superior, homolaterais à mastectomia em mulheres com carcinoma de mama submetidas à preservação ou não do nervo peitoral Medial (NPM). TIPO DE ESTUDO E LOCAL: Ensaio clínico aleatório, duplo-cego, com 30 mulheres com carcinoma de mama submetidas a mastectomias entre julho de 2002 e maio de 2003, em Campinas, Brasil. MÉTODOS: As mulheres foram alocadas em um grupo em que o NPM foi preservado e em outro no qual o NPM foi seccionado. Para análise de dados, foram utilizados os testes exato de Fisher e Wilcoxon, além das análises de variância de Friedman e Anova (análise de variância). RESULTADOS: No grupo com NPM preservado, 81% das mulheres não sofreram perda de força do MPM comparado a 31% no outro grupo (intervalo de confiança, IC = 1.21 e risco relativo, RR = 2.14, P < 0,03). Em relação a trofismo muscular (IC = 0.32 e RR = 0.89, P = 0.8), a abdução (IC = 1.36, RR = 0.89, P = 0.28) e flexão (IC = 1.36, RR = 1.93 e P = 0.8) do ombro homolateral, não houve diferenças entre os grupos. CONCLUSÃO: A preservação do MPM foi significativamente associada a manutenção da força do MPM comparada com a secção do nervo. Não foram encontradas diferenças no trofismo muscular ou na amplitude de movimento do ombro entre os grupos. REGISTRO DE ENSAIO CLÍNICO NUMERO: ACTRN - 1260900094522411712
Rory K J Murphy - One of the best experts on this subject based on the ideXlab platform.
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Medial Pectoral Nerve to axillary Nerve neurotization following traumatic brachial plexus injuries indications and clinical outcomes
Hand, 2012Co-Authors: Rory K J Murphy, Katherine B Santosa, Philip J Johnson, Susan E MackinnonAbstract: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.
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Medial Pectoral Nerve to axillary Nerve neurotization following traumatic brachial plexus injuries: indications and clinical outcomes
HAND, 2012Co-Authors: Wilson Z. Ray, Rory K J Murphy, Philip J Johnson, Katherine Santosa, Susan E MackinnonAbstract: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.