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Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 98-103

A cadaveric feasibility study for a delayed supinator nerve transfer for restoration of hand function after infraclavicular brachial plexus injury

1 Department of Anatomy, University of Birmingham, Birmingham, UK
2 Department of Neurophysiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
3 Department of Anaesthetics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
4 Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Correspondence Address:
Mr. Daniel N Guerero
No. 18 Vincent Drive, Edgbaston, Birmingham, West Midlands, B15 2ST
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmsr.jmsr_99_18

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Objectives: Infraclavicular brachial plexus injury is an uncommon complication of shoulder dislocation. Medial cord injury is known to yield poor functional recovery due to paralysis of the intrinsic hand muscles. This study aims to determine the anatomical feasibility of a conceptual technique involving the use of the lateral cutaneous nerve of the forearm (LCNF) as an in situ reversed vascularized graft with the nerves to supinator as the donor in a staged nerve transfer procedure for medial cord injury. Methods: Limb measurements were conducted on five fresh cadaveric upper limbs and surgical demonstration performed on a formalin-fixed upper extremity. Each arm was dissected by a peripheral nerve surgeon to identify the LCNF, nerve to flexor digitorum profundus (FDP), deep branch of the ulnar nerve (DBUN), and the anterior interosseous nerve (AIN). The distance of each nerve from recognized limb landmarks was measured and neurorrhaphies attempted in surgical demonstration. Results: The mean available length of the LCNF graft was found to be 221.4 mm (range: 103.9–304.4 mm). The mean required graft lengths for medial cord motor targets were 38.6 mm (range: 29.3–51.9 mm) for the nerve to FDP, 164.5 mm (range: 126.7–197.9) for the DBUN, and 177.1 mm (range: 151.4–202.2 mm) for the AIN. Conclusions: Based on the results of this cadaveric study, the LCNF is sufficiently long to form tension-free neurorrhaphies when used as an in situ reversed vascularized graft to reinnervate distal medial cord motor targets.

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