Musculocutaneous neurotization to restore elbow flexion in brachial plexus paralysis. 2006

Marios D Vekris, and Alexandros E Beris, and Elizabeth O Johnson, and Anastasios V Korobilias, and Dimitrios Pafilas, and Anastasios D Vekris, and Panayotis N Soucacos
Department of Orthopedics, Medical School, University of Ioannina, Ioannina, Greece. vekrismd@otenet.gr

Brachial plexus injuries may result in devastating paralysis, especially if they involve all the roots. The upper roots are often traumatized, and therefore elbow flexion is usually lost. The prognosis of these injuries is grave if root avulsions are present and the paralysis includes the hand as well. The current management of brachial plexus injuries should be early, aggressive microsurgical reconstruction of the plexus, combining various neurotizations with intraplexus and extraplexus nerve donors. Following this principle, we present the results of musculocutaneous neurotization in our unit, as well as a review of the literature on this subject. Our results are comparable to those reported in the literature, and indicate that the strongest function is achieved after neurotization via intraplexus donors, while some extraplexus donors (i.e., phrenic and accessory nerve) can offer equally strong elbow flexion, especially if they are used in combination. Neurotization of the musculocutaneous nerve should be one of the primary goals in the reconstruction of the injured plexus, since the return of elbow flexion is of paramount importance in daily activity. The restoration of function is ensured if the stronger and healthier motor donors are dedicated to the neurotization of the musculocutaneous nerve. Sometimes in order to match the axonal number of the target to the lower number of axons offered by the donors, two or more donor nerves may be driven to the same target, such as the musculocutaneous nerve.

UI MeSH Term Description Entries
D008297 Male Males
D004550 Elbow Region of the body immediately surrounding and including the ELBOW JOINT.
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012867 Skin The outer covering of the body that protects it from the environment. It is composed of the DERMIS and the EPIDERMIS.
D018482 Muscle, Skeletal A subtype of striated muscle, attached by TENDONS to the SKELETON. Skeletal muscles are innervated and their movement can be consciously controlled. They are also called voluntary muscles. Anterior Tibial Muscle,Gastrocnemius Muscle,Muscle, Voluntary,Plantaris Muscle,Skeletal Muscle,Soleus Muscle,Muscle, Anterior Tibial,Muscle, Gastrocnemius,Muscle, Plantaris,Muscle, Soleus,Muscles, Skeletal,Muscles, Voluntary,Skeletal Muscles,Tibial Muscle, Anterior,Voluntary Muscle,Voluntary Muscles
D019635 Neurosurgical Procedures Surgery performed on the nervous system or its parts. Procedures, Neurosurgical,Surgical Procedures, Neurologic,Neurologic Surgical Procedure,Neurologic Surgical Procedures,Neurosurgical Procedure,Procedure, Neurologic Surgical,Procedure, Neurosurgical,Procedures, Neurologic Surgical,Surgical Procedure, Neurologic
D020127 Recovery of Function A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma. Function Recoveries,Function Recovery
D020516 Brachial Plexus Neuropathies Diseases of the cervical (and first thoracic) roots, nerve trunks, cords, and peripheral nerve components of the BRACHIAL PLEXUS. Clinical manifestations include regional pain, PARESTHESIA; MUSCLE WEAKNESS, and decreased sensation (HYPESTHESIA) in the upper extremity. These disorders may be associated with trauma (including BIRTH INJURIES); THORACIC OUTLET SYNDROME; NEOPLASMS; NEURITIS; RADIOTHERAPY; and other conditions. (From Adams et al., Principles of Neurology, 6th ed, pp1351-2) Brachial Plexopathy,Erb Paralysis,Klumpke Paralysis,Brachial Plexus Diseases,Brachial Plexus Disorders,Dejerine-Klumpke Palsy,Erb's Palsy,Erb-Duchenne Paralysis,Klumpke's Palsy,Lower Brachial Plexus Neuropathy,Lower Brachial Plexus Palsy,Middle Brachial Plexus Neuropathy,Paralysis of the Lower Brachial Plexus,Upper Brachial Plexus Neuropathy,Brachial Plexus Disease,Brachial Plexus Disorder,Brachial Plexus Neuropathy,Dejerine Klumpke Palsy,Erb Duchenne Paralysis,Erb Palsy,Erb Paralyses,Erb's Palsies,Erb-Duchenne Paralyses,Erbs Palsy,Klumpke Palsy,Klumpkes Palsy,Neuropathies, Brachial Plexus,Neuropathy, Brachial Plexus,Palsies, Erb's,Palsy, Dejerine-Klumpke,Palsy, Erb's,Palsy, Klumpke's,Paralyses, Erb,Paralyses, Erb-Duchenne,Paralysis, Erb,Paralysis, Erb-Duchenne,Paralysis, Klumpke,Plexopathies, Brachial,Plexopathy, Brachial,Plexus Disease, Brachial,Plexus Diseases, Brachial,Plexus Disorder, Brachial,Plexus Disorders, Brachial,Plexus Neuropathies, Brachial,Plexus Neuropathy, Brachial

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