Transfer of a fascicle from the posterior cord to the suprascapular nerve after injury of the upper roots of the brachial plexus: technical case report.
OBJECTIVE
A new nerve transfer technique using a healthy fascicle of the posterior cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction.


METHODS
A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination.


METHODS
The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the posterior cord to the triceps muscle was transferred to the suprascapular nerve. At the time of the 1-year follow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively.


CONCLUSIONS
The posterior cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.
Martins
Roberto Sergio
RS
Peripheral Nerve Surgery Unit, Division of Neurosurgery, University of São Paulo School of Medicine and Hospital do Servidor Público do Estado, São Paulo, Brazil. robar@ig.com.br
Siqueira
Mario Gilberto
MG
Heise
Carlos Otto
CO
Teixeira
Manoel Jacobsen
MJ
D000063:Accidents, Traffic; D001132:Arm / Q000294:innervation / Q000503:physiopathology; D001642:Bicycling / Q000293:injuries; D001917:Brachial Plexus / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003714:Denervation / Q000009:adverse effects; D004558:Electric Stimulation; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D016067:Nerve Transfer / Q000379:methods*; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D012782:Shoulder / Q000294:innervation / Q000503:physiopathology; D013126:Spinal Nerve Roots / Q000033:anatomy & histology / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome