title: Axillary nerve repair by triceps motor branch transfer through an axillary access: anatomical basis and clinical results.
abstract: OBJECTIVE
  Grafting or nerve transfers to the axillary nerve have been performed using a deltopectoral approach and/or a posterior arm approach. In this report, the surgical anatomy of the axillary nerve was studied with the goal of repairing the nerve through an axillary access.
  
  
  METHODS
  The axillary nerve was bilaterally dissected in 10 embalmed cadavers to study its variations. Three patients with axillary nerve injuries then underwent surgical repair through an axillary access; the axillary nerve was repaired by transfer of the triceps long head motor branch.
  
  
  RESULTS
  At the lateral margin of the subscapularis muscle, the axillary nerve was found in the center of a triangle bounded medially by the subscapular artery, laterally by the latissimus dorsi tendon, and cephalad by the posterior circumflex humeral artery. At the entrance of the quadrangular space, the axillary nerve divisions were loosely connected to each other, and could be clearly separated and correctly identified. Surgery for the axillary nerve repair through the axillary access was straightforward. Eighteen months after surgery, all three patients had recovered deltoid strength to a score of M4 on the Medical Research Council scale and had improved abduction strength by 50%. No deficit was evident in elbow extension.
  
  
  CONCLUSIONS
  The axillary nerve and its branches can be safely dissected and repaired by triceps motor nerve transfer through an axillary access.
authors: Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil. bertelli@matrix.com.br
authors: Jayme Augusto
authors: JA
authors: Bertelli
authors: Paulo Roberto
authors: PR
authors: Kechele
authors: Marcos Antonio
authors: MA
authors: Santos
authors: Hamilton
authors: H
authors: Duarte
authors: Marcos Flávio
authors: MF
authors: Ghizoni
mesh_terms: D000328:Adult; D001132:Arm / Q000294:innervation*; D001365:Axilla / Q000294:innervation* / Q000601:surgery; D001917:Brachial Plexus / Q000033:anatomy & histology* / Q000601:surgery*; D002102:Cadaver; D004210:Dissection; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation*; D016067:Nerve Transfer / Q000379:methods*