title: Comparative study of single-, double-, and triple-nerve transfer to a common target: experimental study of rat brachial plexus.
abstract: BACKGROUND
  The purpose of this study was to investigate the recovery of a common target motor function after different single and combined motor nerve transfers in rat brachial plexus model.
  
  
  METHODS
  The musculocutaneous nerve and biceps muscle were chosen as the target for neurotization. The phrenic, pectoral, and suprascapular nerves were selected as the neurotizers. Forty-two Sprague-Dawley rats were randomly assigned to seven groups (six rats in each group): single-neurotizer transfer (three groups), double-neurotizer transfer (three groups), and triple-neurotizer transfer (one group). The contralateral intact forelimb was used as a control. Functional outcomes were measured by grooming test, electrophysiological study, muscle contraction strength, muscle weight, and axon counts.
  
  
  RESULTS
  At 12 weeks, 40 operative rats were studied (two had died). In the single-neurotizer transfer, all three transfers showed no significant difference in motor recovery of the biceps. In the double-neurotizer transfer groups, the worst results were seen in group 6 (combined pectoral and suprascapular nerve transfer) despite increasing axon counts.
  
  
  CONCLUSIONS
  This study may potentially suggest: (1) single-neurotizer transfer will not have synergistic or antagonistic effects; (2) two neurotizers with functional antagonism will significantly downgrade motor recovery of the neurotized muscle despite increasing axon counts; (3) multiple motor neurotizer transfers may not always provide a better outcome, although increasing axons may outweigh antagonistic effects; and (4) phrenic nerve transfer alone did not upgrade the functional outcome despite its automatic discharge. Any nerve transfer combined with phrenic nerve transfer, however, showed improved functional results.
authors.affiliation: Taipei-Linkou, Taiwan From the Departments of Plastic and Reconstructive Surgery, Neurology, and Cardiology, Chang Gung Memorial Hospital, Chang Gung University.
authors.forename: Andrés
authors.initials: A
authors.lastname: Rodriguez
authors.forename: David Chwei-Chin
authors.initials: DC
authors.lastname: Chuang
authors.forename: Kuang-Te
authors.initials: KT
authors.lastname: Chen
authors.forename: Ruei-Feng
authors.initials: RF
authors.lastname: Chen
authors.forename: Rong-Kuo
authors.initials: RK
authors.lastname: Lyu
authors.forename: Yu-Shien
authors.initials: YS
authors.lastname: Ko
mesh_terms: D000818:Animals; D001917:Brachial Plexus / Q000502:physiology / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D004195:Disease Models, Animal; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000294:innervation* / Q000637:transplantation; D016067:Nerve Transfer / Q000379:methods*; D010791:Phrenic Nerve / Q000502:physiology / Q000601:surgery*; D051381:Rats; D017207:Rats, Sprague-Dawley; D020127:Recovery of Function / Q000502:physiology