title: [Nerve transfer between the intercostal nerves and the motor component of the musculocutaneous nerve. Anatomical study of feasibility].
abstract: BACKGROUND
  The intercostal nerves (ICN) transfer to the musculocutaneous nerve (MCN) can restore elbow flexion in complete brachial plexus palsy. The last cases our service dealt with, allowed our staff to observe two different situations. In the 2 first patients, we were able to proceed with an intraneurodissection of the MCN motor component up to the axillary cavity level, while on the third case such dissection could not be performed as high. The aim of this work is to assess the feasibility of a transfer on the MCN's motor component.
  
  
  METHODS
  We conducted a series of 5 cadaver dissections of the MCN and ICN on the anatomy laboratory. Using magnifying loupes to perform an intraneurodissection, we were able to split the motor and sensory fibers as they stood out. It would help motor recuperation avoiding directional error on sensitive component.
  
  
  RESULTS
  The ICN can be sutured on the motor component of the MCN, provided the dissection is very minutious.
  
  
  CONCLUSIONS
  The intraneurodissection of the MCN up to the axillary cavity level is possible as the interfascicular exchanges are scarce there. Publications already refer to the possibility of a nerve transfer between the ICN and the motor component of the MCN. Therefore, our researches suggest that such a procedure can be considered for routine procedures.
  
  
  CONCLUSIONS
  The neurotization is one of the latest breakthroughs in terms of brachial plexus surgery. We are hopeful that anatomical researches could lead to optimization possibilities.
authors.affiliation: Service d'orthopédie, traumatologie, chirurgie plastique, esthétique, reconstructrice assistance main, CHU de Besançon, 2, boulevard Flemming, 25000 Besançon, France. Electronic address: marion.fleury1@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Fleury
authors.affiliation: Service d'orthopédie, traumatologie, chirurgie plastique, esthétique, reconstructrice assistance main, CHU de Besançon, 2, boulevard Flemming, 25000 Besançon, France.
authors.forename: D
authors.initials: D
authors.lastname: Lepage
authors.affiliation: Service d'orthopédie, traumatologie, chirurgie plastique, esthétique, reconstructrice assistance main, CHU de Besançon, 2, boulevard Flemming, 25000 Besançon, France.
authors.forename: I
authors.initials: I
authors.lastname: Pluvy
authors.affiliation: Service d'orthopédie, traumatologie, chirurgie plastique, esthétique, reconstructrice assistance main, CHU de Besançon, 2, boulevard Flemming, 25000 Besançon, France. Electronic address: julien.pauchot@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Pauchot
mesh_terms: D001365:Axilla / Q000294:innervation; D020516:Brachial Plexus Neuropathies / Q000601:surgery; D002102:Cadaver; D004210:Dissection; D005240:Feasibility Studies; D006801:Humans; D007367:Intercostal Nerves / Q000033:anatomy & histology* / Q000601:surgery; D018482:Muscle, Skeletal / Q000294:innervation; D009138:Musculocutaneous Nerve / Q000033:anatomy & histology* / Q000601:surgery; D016067:Nerve Transfer / Q000379:methods; D013536:Suture Techniques
keywords: Brachial plexus; Intercostal nerves transfer; Intraneurodissection; Musculocutaneous nerve; Nerf musculocutané; Nerfs intercostaux; Neurotisation; Neurotisation extraplexuelle; Plexus brachial