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A New Nerve Transfer Strategy for Lower Brachial Plexus Injury, an Anatomic Study
Omar Nazir, MD; Sandeep Mannava, MD; David Schippert, MD; Zhongyu Li, MD; Jonathan Barnwell, MD; Michael Xu, MD; Phillip Mason, MD
Wake Forest University School of Medicine, Winston-Salem, NC, USA
Objective: Injuries to the brachial plexus are devastating, affecting all aspects of a patient’s life. Lower brachial plexus injuries represent the most difficult subset of plexus injuries. Given the unpredictable results of proximal brachial plexus repairs and the time required for axon regeneration, the outcomes are uniformly poor. Distal nerve transfers may be utilized in these injuries. However, there is limited literature illustrating the feasibility of nerve transfers in lower brachial plexus injuries. The purpose of the study is to test our hypothesis that it is possible to use intraneural fascicular transfers for re-animation of the hand function in lower brachial plexus injury patients.
Methods: A human fresh cadaver model was used to test the feasibility of transferring the pronator branch of the median nerve to the anterior interosseous nerve (AIN) and the supinator branches of the radial nerve to the posterior interosseous nerve (PIN). An anatomic study was completed utilizing ten arms from five cadavers. The AIN and pronator branches as well as the PIN and supinator branches were identified and evaluated in all specimens. Distances from branching points, nerve diameters and histology were obtained. The nerve transfers were then attempted to directly assess feasibility based branch pattern, size, length and axon counts.
Results: Our results indicate that Pronator teres receives two major branches from the median nerve and the length and diameter of the pronator branches of the median nerve make it amenable for transfer to the AIN. Similarly, there are two major radial nerve branches innervating the supinator muscle making it possible to transfer one of the supinator branches of the radial nerve to the PIN.
Conclusions: The findings of this study confirm that both the pronator branch to AIN and supinator branch to PIN nerve transfers are anatomically possible. These transfers may allow for restoration of functional loss following lower brachial plexus injuries.
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