title: Selective neurotization of the radial nerve in the axilla using a full-length phrenic nerve to treat complete brachial plexus palsy: an anatomic study and case report.
abstract: BACKGROUND
  Current methods for the restoration of wrist and digit extension after a complete brachial plexus injury result in poor outcomes.
  
  
  OBJECTIVE
  To determine the internal topography of the radial nerve in the axilla and present a method for selective neurotization of the radial nerve using a full-length phrenic nerve.
  
  
  METHODS
  Internal topographic features of the fascicular groups of the radial nerve were observed at the level of latissimus dorsi insertion in 16 cadavers. Selective neurotization of the medial portion of the antebrachial part of the main trunk of the radial nerve was performed at this level using a full-length phrenic nerve in one patient with complete brachial plexus palsy.
  
  
  RESULTS
  At the level of latissimus dorsi insertion in the axilla, the antebrachial part of the radial nerve, which innervates the forearm extensors, is located at the superior lateral part of the radial nerve trunk. It can be divided into medial and lateral portions. Transfer of a full-length phrenic nerve was used to selectively reinnervate the medial portion of the antebrachial part of the radial nerve in 1 patient with complete brachial plexus palsy. The patient's antebrachial extensor muscles regained Grade 4 power when assessed 3 years after surgery.
  
  
  CONCLUSIONS
  The fibers that innervate the antebrachial extensors are located at the superior lateral part of the radial nerve trunk in the axilla. Selective neurotization of the radial nerve at this level with a phrenic nerve was performed successfully in 1 patient.
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: JianYun
authors.initials: J
authors.lastname: Yang
authors.forename: Lin
authors.initials: L
authors.lastname: Chen
authors.forename: YuDong
authors.initials: Y
authors.lastname: Gu
authors.forename: DeSong
authors.initials: D
authors.lastname: Chen
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001132:Arm / Q000294:innervation* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D006801:Humans; D008297:Male; D009049:Motorcycles; D018482:Muscle, Skeletal / Q000294:innervation; D016067:Nerve Transfer / Q000379:methods*; D010791:Phrenic Nerve / Q000601:surgery*; D011826:Radial Nerve / Q000033:anatomy & histology / Q000601:surgery*; D020127:Recovery of Function