Treatment Of Brachial Plexus Injuries Research Articles

Positive effect of ulnar nerve fascicle transfer to musculocutaneous nerve seeded with allogeneic adipose tissue derived stem cells on nerve regeneration for repairing upper brachial plexus injury in a rat model: A preliminary study.

Traumatic peripheral nerve injury, with an annual incidence reported to be approximately 13-23 per 100,000 people, is a serious clinical condition that can often lead to significant functional impairment and permanent disability. Although nerve transfer has become increasingly popular in the treatment of brachial plexus injuries, satisfactory results cannot be obtained even with total nerve root transfer, especially after serious injuries. To overcome this problem, we hypothesize that the application of stem cells in conjunction with nerve transfer procedures may be a viable alternative to more aggressive treatments that do not result in adequate improvement. Similarly, some preliminary studies have shown that adipose stem cells combined with acellular nerve allograft provide promising results in the repair of brachial plexus injury. The purpose of this study was to assess the efficacy of combining adipose-derived stem cells with nerve transfer procedure in a rat brachial plexus injury model. Twenty female Wistar rats weighing 300-350 g and aged 8-10 weeks were randomly divided into two groups: a nerve transfer group (NT group) and a nerve transfer combined adipose stem cell group (NT and ASC group). The upper brachial plexus injury model was established by gently avulsing the C5-C6 roots from the spinal cord with microforceps. A nerve transfer from the ulnar nerve to the musculocutaneous nerve (Oberlin procedure) was performed with or without seeded allogeneic adipose tissue-derived stem cells. Adipose tissue-derived stem cells at a rate of 2 × 106 cells were injected locally to the surface of the nerve transfer area with a 23-gauge needle. Immunohistochemistry (S100 and PGP 9.5 antibodies) and electrophysiological data were used to evaluate the effect of nerve repair 12 weeks after surgery. The mean latency was significantly longer in the NT group (2.0 ± 0.0 ms, 95% CI: 1.96-2.06) than in the NT and ASC group (1.7 ± 0.0 ms, 95% CI: 1.7-1.7) (p < .001). The mean peak value was higher in the NT group (1.7 ± 0.0 mV, 95% CI: 1.7-1.7) than in the NT and ASC group (1.7 ± 0.3 mV, 95% CI: 1.6-1.9) with no significant difference (p = .61). Although S100 and PGP 9.5 positive areas were observed in higher amounts in the NT and ASC group compared to the NT group, the differences were not statistically significant (p = .26 and .08, respectively). This study conducted on rats provides preliminary evidence that adipose-derived stem cells may have a positive effect on nerve transfer for the treatment of brachial plexus injury. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.

Global trends and outcomes of nerve transfers for treatment of adult brachial plexus injuries.

The presentation, management and outcomes of brachial plexus injuries are likely to be subject to regional differences across the globe. A comprehensive literature search was performed to identify relevant articles related to spinal accessory to suprascapular, intercostal to musculocutaneous, and ulnar and/or median nerve fascicle to biceps and/or brachialis motor branch nerve transfers for treatment of brachial plexus injuries. A total of 6007 individual brachial plexus injuries were described with a mean follow-up of 38 months. The specific indication for accessory to suprascapular and intercostal to musculocutaneous transfers were considerably different among regions (e.g. upper plexus vs. pan-plexal), while uniform for fascicular transfer for elbow flexion (e.g. upper plexus +/- C7). Similarly, functional recovery was highly variable for accessory to suprascapular and intercostal to musculocutaneous transfers, while British Medical Research Council grade ≥3 strength after fascicular transfer for elbow flexion was frequently obtained. Overall, differences in outcomes seem to be inherent to the specific transfer being utilized.Level of evidence: III.

Treatment of Brachial Plexus Injuries following Gunshot Injuries: A Systematic Review.

Brachial plexus injuries (BPI) from gunshot injuries are uncommon but usually severe and can cause chronic pain, loss of function, and permanent nerve damage. Multiple surgical techniques including neurolysis, end-to-end suture repair, and graft repair have been described for the treatment of these injuries. However, surgical indication, timing, and technique for these injuries remain controversial. This systematic review aims to investigate the treatment modalities for patients with BPI due to gunshot-related injuries. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology was employed for this review. PubMed, Cochrane Reviews, Embase, and CINAHL databases were included. The following keywords constituted our search criteria: gun-shot-wounds, brachial plexus, traum∗, and management. A total of 90 studies were imported for screening, from which 9 papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were retrospective chart reviews followed by case series. In total, there were 628 patients that suffered from gunshot wounds to the brachial plexus. Most patients underwent some form of delayed nerve repair consisting of neurolysis, end-to-end epineural repair, or graft repair with a sural or antebrachial cutaneous nerve graft. Several patients suffered from complications, with neuroma being the most common long-term complication that required reoperation. The optimal timing for surgeries involving BPIs should be determined after examining the level of nerve damage, associated injuries, operative risks, and electrophysiological workup for indications of spontaneous regeneration. Early surgical interventions were indicated for patients presenting with associated vascular or thoracic injuries, compressive masses, and nerve transection by sharp instruments in most selected papers.

Risk prediction model for unsuccessful elbow flexion recovery after nerve transfer surgery in patients with brachial plexus injury.

Nerve transfer surgery has been a mainstay treatment of brachial plexus injury, with varying success rates. Patients undergoing unsuccessful surgery are left with a useless limb for at least 2 years. Preoperative prediction has become a topic of interest to avoid an unsuccessful nerve transfer surgery. This study aimed to find strong predictive factors and develop a prediction model for unsuccessful functional elbow flexion recovery 2 years after a nerve transfer surgery in patients with brachial plexus injury. This retrospective study reviewed the medical records of 987 patients with traumatic brachial plexus injury who underwent brachial plexus surgery by five hand and microsurgery surgeons at a single tertiary care referral center from December 2001 to July 2018. Four hundred thirty-three patients were eligible for analysis. Patient demographic data, injury factors, surgical details, and postoperative factors were collected. Multivariable logistic regression was used to identify strong prognostic factors for unsuccessful nerve transfer surgery for elbow flexion. A simplified model was developed by rounding the coefficient to the nearest 0.5 score or an integer. Both original and simplified models were validated using the Hosmer-Lemeshow goodness-of-fit test and bootstrapping. A full, original prognostic model from a stepwise backward logistic regression consisted of a BMI ≥ 23 kg/m2 (p = 0.015), smoking (p = 0.046), total arm-type injury (p = 0.033), donor nerve (p < 0.001), associated upper-extremity fracture (p = 0.013), and associated ipsilateral vascular injury (p = 0.095). The areas under the receiver operating characteristic curve of the original and simplified models were 0.765 and 0.766, respectively. The Hosmer-Lemeshow test showed good agreement of predicted and observed probability of the original (p = 0.49) and simplified (p = 0.19) models. Bootstrapping estimated an average optimism (1.9%) in the original model and minimal optimism (0.1%) in the simplified model. The prediction model for failed elbow flexion recovery after nerve transfer surgery in traumatic brachial plexus injury was developed with good predictive value and internal validity. An alternative treatment, i.e., primary free functioning muscle transfer, should be offered in preoperative counseling in cases of a very high risk of failure.

Efficacy of Naprapathy in Brachial Plexus Injury: Protocol for a Randomized Clinical Trial.

Clinical rehabilitation for brachial plexus injury is difficult in terms of chronic pain and dysfunction. Physiotherapy is considered a routine intervention for rehabilitation. Common physical therapy may require a variety of instruments. One approach that does not need instruments, but belongs to the field of complementary and alternative medicine, is naprapathy. Naprapathy, also called Tuina in China, has been applied in rehabilitation after brachial plexus injury for a long time. Naprapathy can relieve chronic neuropathic pain, promote local blood circulation, and improve body edema. Naprapathy can passively help improve motor functions in patients with peripheral nerve injury. However, the efficacy of naprapathy in improving rehabilitation after brachial plexus injury is unclear. This study aims to evaluate the additional value of naprapathy when combined with conventional physical therapy for the treatment of brachial plexus injury. This will be a single-center randomized controlled trial. A total of 116 eligible patients with brachial plexus injury will be randomly divided into an experimental group (naprapathy plus physical therapy group) or a control group (physical therapy group). The participants will be followed up for 4 weeks of treatment. Observation outcomes will include the visual analog scale score, upper limb index, electromyography findings, and adverse reactions, among others. The measuring points for outcomes will be the baseline and the completion of treatment. In addition, a quality control group independent from the research team will be set up to control the quality of the trial. Finally, the data will be analyzed using SPSS software (version 21.0; IBM Corp). The study is recruiting participants. The first participant was enrolled in September 2021. As of January 2023, a total of 100 participants have been enrolled. The trial is expected to be completed by September 2023. The study protocol was approved by the Ethics Review Committee of Yue Yang Hospital affiliated with the Shanghai University of Traditional Chinese Medicine (2021-012). One limitation of this trial is that we will be unable to achieve strict double-blinding because of the features of naprapathy. The trial aims to contribute reliable evidence for decision-making in naprapathy for treating brachial plexus injury. Chinese Clinical Trial Registry ChiCTR2100043515; http://www.chictr.org.cn/showproj.aspx?proj=122154. DERR1-10.2196/46054.

Review of rehabilitation protocols for brachial plexus injury.

Brachial plexus injury (BPI) is one of the most serious peripheral nerve injuries, resulting in severe and persistent impairments of the upper limb and disability in adults and children alike. With the relatively mature early diagnosis and surgical technique of brachial plexus injury, the demand for rehabilitation treatment after brachial plexus injury is gradually increasing. Rehabilitation intervention can be beneficial to some extent during all stages of recovery, including the spontaneous recovery period, the postoperative period, and the sequelae period. However, due to the complex composition of the brachial plexus, location of injury, and the different causes, the treatment varies. A clear rehabilitation process has not been developed yet. Rehabilitation therapy that has been widely studied focusing on exercise therapy, sensory training, neuroelectromagnetic stimulation, neurotrophic factors, acupuncture and massage therapy, etc., while interventions like hydrotherapy, phototherapy, and neural stem cell therapy are less studied. In addition, rehabilitation methods in some special condition and group often neglected, such as postoperative edema, pain, and neonates. The purpose of this article is to explore the potential contributions of various methods to brachial plexus injury rehabilitation and to provide a concise overview of the interventions that have been shown to be beneficial. The key contribution of this article is to form relatively clear rehabilitation processes based on different periods and populations, which provides an important reference for the treatment of brachial plexus injuries.

Transposition of functioning muscles in complex treatment of adult patients with injuries of the bracheric plexus (literature review)

Introduction. Injuries to the brachial plexus are one of the most severe types of injuries to the nerves of the upper limb, and variants with the separation of the roots from the spinal cord represent a very difficult category of injuries to treat. Among patients who have received such injuries, there is a very high incidence of disability, since it is possible to achieve only partial restoration of the function of the upper limb. Recently, the method of transposition of functioning muscles has been growing in popularity due to its reliability and relatively short recovery time of function.The purpose of the work is to analyze the literature data on the possibility of using the method of transposition of functioning muscles in the complex treatment of victims with brachial plexus injuries.The authors have searched PubMed and RSCI databases over the past 25 years for keywords: peripheral nerve damage, tendon transposition, transposition of functioning muscles, nerve injury, brachial plexus injury, spinal cord root avulsion. In the selected 23 most relevant papers, the muscles used for transposition, indications and timing of operations, results and complications were analyzed, compared with other methods of surgical treatment of brachial plexus injuries. The analysis of studies has shown that the transposition of functioning muscles allows in most cases to restore the target movement to the useful level of M3–M4 on the MRC scale, is a more reliable method and allows achieving better results, especially in patients with severe complete injuries of the brachial plexus. An important disadvantage of free hip thin muscle transplantation operations is the risk of microanastomosis thrombosis, which requires detailed preoperative planning and good microsurgical technique of the operating team.Conclusion. Free transplantation of 2 functioning muscles is currently the method of choice for restoring upper limb movements in patients with complete brachial plexus injuries.

Differences in the surgical treatment of adult and pediatric brachial plexus injuries among peripheral nerve surgeons

ObjectivesPeripheral nerve surgeons disagree on the optimal timing and treatment of brachial plexus injuries (BPI). This study aims to survey peripheral nerve surgeons on their management of BPI, including disagreement. MethodsSurgeons responded to a case-based survey involving traumatic and birth injuries leading to BPI involving the upper and lower trunks, and pre- and post-ganglionic injuries. ResultsOut of 255 invited surgeons, 154 participated, with specialties of Neurosurgery (33.7%), Plastic surgery (32.5%), and Orthopedics (32.5%). For the adult C5–6 avulsion injury, 97.4% agreed they would operate. There was 46.2% disagreement regarding the pediatric upper trunk neuroma-in-continuity case, and similar disagreement (50.0%) was recorded on exploring the brachial plexus for a pediatric lower trunk injury case. High percentages of surgeons were more likely to explore the plexus, such as at upper BPI. Also, most participants reported nerve transfer for the upper and lower trunk avulsion injuries, but there was 55.6% disagreement regarding nerve transfer for the infant with the upper trunk neuroma-in-continuity. Among those elected to perform nerve transfer, most (70.0%−84.5%) would perform an accessory-to-suprascapular nerve transfer for upper BPI, while brachialis-to-anterior interosseous and supinator branch of the radial nerve-to-posterior interosseous were preferred for lower BPI (30.0%−55.9%). ConclusionsSubstantial disagreement exists among peripheral nerve surgeons in managing adult and pediatric BPI. In adult BPI, most prefer to operate at the time of the presentation and perform extensive nerve transfers. The accessory-suprascapular transfer was recommended for upper BPI, while brachialis and radial nerves were preferred for lower BPI. The most significant disagreements exist in operation and nerve transfer for pediatric upper BPI and brachial plexus explorations. Geography, specialty, and operative volume contribute to the differences seen.

Innovation and Adaptation

Innovation has been the cornerstone for advances in any field of endeavor throughout the history of man and has driven the relentless forward journey of the human race. This special Orthopedics issue highlights a number of articles that showcase innovations – ideas, devices, and systems.&#x0D; The article by Aljibe, et al. showcases a novel method of producing patient-specific templates. While it is still in its infancy, the in vitro model is a first step towards a goal of translating this technology into surgical applications. This is an example of innovation driving medicine forward. 3-D printing has evolved from a hobbyist’s dream to an important tool in prosthetics, industry, drug delivery, and medicine.1-3 It is certainly exciting that scientists, engineers, and medical practitioners in our country are beginning to engage in this trailblazing field.&#x0D; The article by Gavino, et al. combines two highly specialized procedures – brachial plexus reconstruction and markerless motion analysis, the latter an innovation in itself, and creates a novel method of evaluating results of surgical procedures.4,5 Treatment of brachial plexus injuries, which bring catastrophic damage to the nerve supply to the upper extremity, need accurate evaluation of their outcomes. Only by knowing what is achieved by current treatments can we hope to better the plight of these patients.&#x0D; Genuino, et al. present a paradigm shift in delivery of services in a tertiary hospital whose main client base are the indigent. An innovation in the provision of necessary orthopedic implants to patients who have no capacity to pay for these themselves allows the bypass of charitable donors and puts the responsibility of supplying and paying for these implants on the government. This is a small but vital cog in the journey towards universal health care.&#x0D; Adaptation is highlighted by the changes forced upon us by the COVID-19 pandemic. The treatment of fragility fractures, a fraught process in the best of times, was further complicated with the restrictions that came with the lockdown. Risks already present in this elderly population were compounded by risks of transmission of this modern plague.6,7 Tabu and Cortez present in their article the adaptations instituted and the short-term results of fragility fractures managed during this period. Education also needed to adapt to the changing milieu.8 Online and distance education became a mainstay in medical education and training. Garduce, et al. present their evaluation of a hybrid method of residency education.&#x0D; The rest of the articles included in this Orthopedics special issue represent continuing efforts in scientific research in our field. They showcase contributions to the body of knowledge and experience that should prove useful to our readers and ultimately, to our patients.&#x0D; Tammy L. Dela Rosa, MD, MMedScDepartment of Orthopedics,Philippine General Hospital, University of the Philippines ManilaDepartment of Biochemistry and Molecular Biology,College of Medicine, University of the Philippines Manila&#x0D; &#x0D; REFERENCES&#x0D; 1. Lambert KF, Whitehead M, Betz M, Nutt J, Dubose C. An overviewof 3-D printing for medical applications. Radiol Technol. 2022Mar;93(4):356-67.2. Zeeshan F, Madheswaran T, Pandey M, Gorain B. Three-dimensional(3-D) printing technology exploited for the fabrication of drugdelivery systems. Curr Pharm Des. 2018;24(42):5019-28. doi: 10.2174/1381612825666190101111525.3. Pehde CE, Bennett J, Lee Peck B, Gull L. Development of a 3-Dprinting laboratory for foot and ankle applications. Clin PodiatrMed Surg. 2020 Apr;37(2):195-213. doi: 10.1016/j.cpm.2019.12.011.4. Rammer J, Slavens B, Krzak J, Winters J, Riedel S, Harris G.Assessment of a markerless motion analysis system for manualwheelchair application. J Neuroeng Rehabil. 2018 Nov;15(1):96.doi: 10.1186/s12984-018-0444-1.5. Huber ME, Seitz AL, Leeser M, Sternad D. Validity and reliabilityof Kinect skeleton for measuring shoulder joint angles: a feasibilitystudy. Physiotherapy. 2015 Dec;101(4):389-93. doi: 10.1016/j.physio.2015.02.002.6. Cortez KA, Lai JGL, Tabu IA. Economic burden and the effectsof early versus delayed hospitalization on the treatment cost ofpatients with acute fragility hip fractures under the UPM-PGHOrthogeriatric Multidisciplinary Fracture Management Model andFracture Liaison Service. Osteoporos Sarcopenia. 2021 Jun;7(2): 63–8.doi: 10.1016/j.afos.2021.05.004. 7. Pouramin P, Li CS, Busse JW, Sprague S, Devereaux PJ, Jagnoor J, et al.Delays in hospital admissions in patients with fractures across 18 lowincome and middle-income countries (INORMUS): A prospectiveobservational study. Lancet Glob Health. 2020 May; 8(5): e711-20.doi: 10.1016/S2214-109X(20)30067-X.8. Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P,Sideris M. Medical and surgical education challenges and innovationsin the COVID-19 Era: a systematic review. In Vivo. 2020 Jun;34(3 Suppl):1603-11. doi: 10.21873/invivo.11950.

Treatment of a damaged brachial plexus with help of stromal vascular fraction cell from adipose tissue

The aim of the study – to accelerate the repair of the damaged brachial plexus using cells of the stromal vascular fraction isolated from adipose tissue.Materials and methods. The study was carried out in 62 patients using stromal-vascular fraction cells from adipose tissue and classical methods of treatment for brachial plexus injury. The effectiveness of regeneration was evaluated using electromyographic examination and positive recovery of motor and sensory function.Results and discussion. Assessment of the results of surgical treatment with stromal vascular fraction cells from adipose tissue after brachial plexus neurolysis revealed the restoration of early M3-M5 and S3-S4 functions in 90 % of patients, and in the comparison group – 68 % respectively. The number of patients with M4-M5 functions in the group using the stromal vascular fraction for brachial plexus neurotization was 85 %, while in the control group it was 64 %, respectively. Electroneuromyography data also indicated an increase in the average number of motor units by 30 % after using cells of the stromal-vascular fraction from adipose tissue, in contrast to the comparison group.Conclusion. Stromal vascular cells isolated from adipose tissue appear to be promising stimulants of brachial plexus injury repair.

A multidisciplinary approach to the management of brachial plexus injuries: experience from the Mayo Clinic over 100 years.

A multidisciplinary brachial plexus clinic has been a relatively new concept, offering different surgical speciality perspectives on the treatment of brachial plexus injuries. The resulting collaborative effort has proven to be greater than the sum of its parts. In this review, the history, philosophy of care, development/implementation and impact of a creation of a multidisciplinary brachial plexus team at the Mayo Clinic are detailed.

Conservative treatment for brachial plexus injury after a displaced clavicle fracture: a case report and literature review

BackgroundA brachial plexus injury is a rare complication of clavicle fractures. Previous case reports only examined the surgical outcomes of brachial plexus injuries that occurred after a clavicle fracture and did not report on the outcomes of conservative treatment. In this report, we present the prognosis of a patient with an acute displaced clavicle fracture accompanied by a brachial plexus injury that was conservatively treated.Case presentationA 51-year-old man with a middle-third clavicle fracture due to a direct trauma after falling down the stairs. A brachial plexus injury experienced symptoms, including numbness occurred in the affected upper extremity, at 1 day after the injury. The patient’s motor power in the elbow, wrist, and hand decreased at 3 days after the injury. Magnetic resonance imaging (MRI) showed no loss of continuity in the brachial plexus, but showed nerve compression by displaced fracture fragments. Electromyography revealed brachial plexopathy. Conservative treatment, including a shoulder sling, was performed with satisfactory outcomes; the patient reported a 70% improvement at 6 months after the injury.ConclusionsA brachial plexus injury is a rare complication of clavicle fractures that can cause serious dysfunction of the upper extremities affected by the injury. Conservative treatment may be considered for acute nerve compression by displaced fracture fragments rather than extensive callus or granulation tissue formation to achieve a satisfactory recovery in young patients. MRI should typically be performed before making a treatment decision to examine the brachial plexus for any discontinuity or kinking.

Possible donor nerves for axillary nerve reconstruction in dual neurotization for restoring shoulder abduction in brachial plexus injuries: a systematic review and meta-analysis.

Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and suprascapular nerve is widely used and considered the best option. The most common donor nerve for the suprascapular nerve is the spinal accessory nerve. However, donor nerves for axillary nerve reconstructions vary and it is still unclear which donor nerve has the best outcome. The aim of this study was to perform a systematic review on reconstructions of suprascapular and axillary nerves and to perform a meta-analysis investigating the outcomes of different donor nerves on axillary nerve reconstructions. We conducted a systematic search of English literature from March 2001 to December 2020 following PRISMA guidelines. Two outcomes were assessed, abduction strength using the Medical Research Council (MRC) scale and range of motion (ROM). Twenty-two studies describing the use of donor nerves met the inclusion criteria for the systematic review. Donor nerves investigated included the radial nerve, intercostal nerves, medial pectoral nerve, ulnar nerve fascicle, median nerve fascicle and the lower subscapular nerve. Fifteen studies that investigated the radial and intercostal nerves met the inclusion criteria for a meta-analysis. We found no statistically significant difference between either of these nerves in the abduction strength according to MRC score (radial nerve 3.66 ± 1.02 vs intercostal nerves 3.48 ± 0.64, p = 0.086). However, the difference in ROM was statistically significant (radial nerve 106.33 ± 39.01 vs. intercostal nerve 80.42 ± 24.9, p < 0.001). Our findings support using a branch of the radial nerve for the triceps muscle as a donor for axillary nerve reconstruction when possible. Intercostal nerves can be used in cases of total brachial plexus injury or involvement of the C7 root or posterior fascicle. Other promising methods need to be studied more thoroughly in order to validate and compare their results with the more commonly used methods.

An electroencephalography-based human-machine interface combined with contralateral C7 transfer in the treatment of brachial plexus injury.

Transferring the contralateral C7 nerve root to the median or radial nerve has become an important means of repairing brachial plexus nerve injury. However, outcomes have been disappointing. Electroencephalography (EEG)-based human-machine interfaces have achieved promising results in promoting neurological recovery by controlling a distal exoskeleton to perform functional limb exercises early after nerve injury, which maintains target muscle activity and promotes the neurological rehabilitation effect. This review summarizes the progress of research in EEG-based human-machine interface combined with contralateral C7 transfer repair of brachial plexus nerve injury. Nerve transfer may result in loss of nerve function in the donor area, so only nerves with minimal impact on the donor area, such as the C7 nerve, should be selected as the donor. Single tendon transfer does not fully restore optimal joint function, so multiple functions often need to be reestablished simultaneously. Compared with traditional manual rehabilitation, EEG-based human-machine interfaces have the potential to maximize patient initiative and promote nerve regeneration and cortical remodeling, which facilitates neurological recovery. In the early stages of brachial plexus injury treatment, the use of an EEG-based human-machine interface combined with contralateral C7 transfer can facilitate postoperative neurological recovery by making full use of the brain’s computational capabilities and actively controlling functional exercise with the aid of external machinery. It can also prevent disuse atrophy of muscles and target organs and maintain neuromuscular junction effectiveness. Promoting cortical remodeling is also particularly important for neurological recovery after contralateral C7 transfer. Future studies are needed to investigate the mechanism by which early movement delays neuromuscular junction damage and promotes cortical remodeling. Understanding this mechanism should help guide the development of neurological rehabilitation strategies for patients with brachial plexus injury.

Применение клеток стромально-васкулярной фракции аутожировой ткани в хирургии повреждений плечевого сплетения

The purpose — to evaluate the therapeutic properties of cells of the stromal vascular fraction isolated from adipose tissue of injuries of brachial plexus. Material and methods. The study was carried out on 62 patients using cells of the stromal vascular fraction and classical methods of treatment for brachial plexus injury. The efficiency of regeneration was assessed using electromyography and a positive recovery of motor and sensory functions. Results. Evaluation of the results of surgical treatment using cells of the stromal vascular fraction after neurolysis of the brachial plexus showed the restoration of early function of M3-M5 and S3–S4 in 90% of patients, and in the comparison group 68%. The number of patients with M4–M5 functions in the group with the use cells of the stromal vascular fraction for brachial plexus neurotization was 85%, while in the control group it was 64%. The ENMG study data also indicated an increase in the average number of motor units by 30% after the use of cells of the stromal vascular fraction, in contrast to the comparison group. Conclusion. Cells of the stromal vascular fraction from adipose tissue appear to be promising stimulators for the regeneration for recovery from trauma to the brachial plexus.

Treatment of Brachial Plexus Injury Following Transaxillary Thyroidectomy

Treatment of Brachial Plexus Injury Following Transaxillary Thyroidectomy

Multidisciplinary Consensus: Brachial Plexus Injuries. Basic Principles of Diagnostics and Treatment

Summary. Brachial plexus injuries is a severe and debilitating trauma characterized by gross impairment of upper extremity function. Mostly this is the trauma of young active people of working age, which often leads to significant loss of upper extremity function and disability of the patient. On October 10, 2019, at the XVIII Congress of Orthopedists Traumatologists of Ukraine held in Ivano-Frankivsk, a round table was held on the basic issues of diagnosis and treatment of patients with brachial plexus injuries, and a multidisciplinary consensus was adopted on the basic principles of diagnosis and treatment of brachial plexus injuries. During the round table, the issues of determining risk groups for brachial plexus injury (patients with polytrauma, road trafic accident, patients with injuries of the shoulder girdle area, dislocations of the shoulder, open lesions of the shoulder girdle and subclavian area, patients with atypical pain in the shoulder, patients that lost upper extremity function after surgery in the supraclavicular and subclavian area, neck, mastectomy, radiation therapy) and the protocol of clinical examination of patients (which must include the possibility of active movements in the joints of the upper limb and stabilization of the scapula; it is obligatory to determine the strength of the muscles of the affected limb in comparison with the healthy one, to determine sensitivity in the corresponding areas of autonomous innervation of the roots; also it is important to determine Horner syndrome) were discussed. Also, the place and time of additional diagnostics methods (emergency ultrasound and radiography, after 3 weeks – needle and stimulation electroneuromyography (ENMG), MRI of the brachial plexus or cervical spine, CT myelography) and an algorithm for the supervision of patients with a brachial plexus injury were adopted; the centers of brachial plexus surgery were specified. All this later formed the basis of multidisciplinary consensus.

Nerve Reconstruction and Tendon Transfers for Treatment of Brachial Plexus Injuries

The complexity of each brachial plexus injury (BPI) pattern and physiologic limitations of nerve regeneration create challenges for BPI patients and their surgeons. Detailed assessment via physical examination, electrodiagnostic studies, and advanced imaging can aid the surgeon in predicting the prognosis for each patient’s neurologic recovery and provide an outline for reconstructive priorities. Surgical exploration of the brachial plexus confirms the injury pattern and guides the overall treatment strategies. A multimodal reconstructive strategy including nerve grafting, extraplexal nerve transfers, distal intraplexal nerve transfers, and free-functioning muscle transfers is designed for each patient to accomplish the goals of providing a pain-free helper hand. Additional reconstructive procedures such as tendon transfers and selective joint arthrodeses are used after the results of the initial reconstructive efforts have been declared. Beyond the neurologic components of BPI, the surgeon must be attuned to the social and psychological sequelae of this devastating injury. This review contains 10 figures, 1 table, and 60 references. Key Words: brachial plexus injury, elbow flexion, free-functioning muscle transfer, nerve grafting, nerve transfer, reconstruction, shoulder abduction, , tendon transfer

Early neurotization of high ulnar nerve injury using anterior interosseous nerve for restoration of intrinsic muscles function

Abstract:Back ground: Nerve transfer surgery, also known as neurotization, developed in the mid- 1800s with the use of animal models, and was used in the treatment of brachial plexus injuries. Neurotization relies on the fact that high ulnar nerve lesions usually have a poor prognosis because of the long distance between the site of injury and the targeted intrinsic muscles of the hand. Expendable motor or sensory nerves can be re-directed in proximity of a specific target, whether a muscle or skin territory, in order to obtain faster re-innervation. Aim of the work: was to evaluate the outcome and functional results of early neurotization of high ulnar nerve injury. Methods: A total of 12 patients, 9 males and 3 females were included in this study and underwent neurotization of high ulnar nerve injury using anterior interosseous nerve transfer to deep motor branch of ulnar nerve at Plastic Surgery Unit, faculty of medicine, Zagazig university hospitals in the period from 12/2017 to 2/2019. Results: nerve transfer provides satisfactory regaining of function in small muscles of hand and prevent permanent handicapping of the affected hand. Conclusion: Neurotization of high ulnar nerve injuries is a simple procedure that provides a good option to restore the ulnar nerve functions in cases of high ulnar nerve lesions. The procedure is easy to perform, with minimal donor-site morbidity.Keywords: Nerve transfer, High ulnar nerve injury, anterior interosseous nerve.

Sensory Nerve Transfer for Lower Roots Brachial Plexus Injury: Superficial Radial Nerve to the Dorsal Cutaneous Branch and the Superficial Branch of the Ulnar Nerve

In the treatment of brachial plexus injury to lower nerve roots, the priority is to restore motor function to the paralyzed hand. In addition, it is also important to consider sensory reconstruction, which is crucial to the optimal restoration of prehensile function. We report the surgical technique and sensory recovery of a nerve transfer in a case in which the superficial radial nerve was transferred to the dorsal cutaneous branch and the superficial branch of the ulnar nerve in a patient with C7, C8, and T1 roots injury. The nerve transfer successfully restored sensation in the ulnar one and a half digits as well as the ulnar border of the hand, with minimal donor site deficit. This technique provides a useful sensory reconstructive option in patients with brachial plexus injury to lower roots.