Courtesy : Authors: Susan E. Mackinnon, Andrew Yee Affiliation: Washington University School of Medicine Division of Plastic Reconstructive Surgery, Department of Surgery, Saint Louis, MO Peripheral Nerve Surgery: http://nervesurgery.wustl.edu
Medial Triceps to Anterior Branch of Axillary Nerve Transfer: A Case of Specific Reinnervation
Standard Edition (150227.150302)
The axillary nerve has several distal branches that provide shoulder function through the innervation of the anterior, middle, and posterior deltoid and teres minor, as well as sensation to the lateral arm. Injury to the axillary nerve has been traditionally viewed as either a complete non-favorable injury where recovery does not occur or a favorable injury where recovery does occur. However, there are situations of mixed injuries where both these scenarios are true, and the axillary nerve has components that will and will not recovery. This mixed nerve injury can be confirmed with the use of electrodiagnostic studies. Management of these cases is to reinnervate the non-recovering components, while protecting the recovering components. The medial triceps branch is an available donor for reconstruction. In this case, the patient suffered an upper brachial plexus injury following a severe fall and lost shoulder function. Electromyography at three months post-injury reported motor unit potentials in the middle and posterior deltoid to recovery, however the anterior deltoid did not have motor unit potentials. Specific reinnervation of the anterior branch of the axillary nerve using medial triceps branch nerve transfer was elected. This video details the specifics of this nerve transfer.
Tables of Contents (Standard)
00:25 Incision and Superficial Dissection
02:15 Dissection along the Posterior Border of the Deltoid
03:09 Identifying the Superior Lateral Cutaneous Branch and Axillary Nerve
05:49 Identifying the Teres Minor and Exposure of Quadrangular Space
07:53 Electrical Stimulation and Dissection of Anterior Branch of Axillary Nerve
09:33 Fascicular Neurolysis of Individual Anterior Branches of Axillary Nerve
10:18 Dissection of Individual Recipient Anterior Branch of Axillary Nerve
11:57 Exposure between the Long and Lateral Heads of the Triceps
12:22 Identifying the Teres Major and Exposure of Triangular Space
13:25 Identification of the Radial Nerve and Triceps Branches
14:40 Additional Dissection between the Heads of Triceps for Distal Exposure
15:28 Dissection of the Donor Medial Triceps Branch
16:15 Proximal Dissection and Division of Anterior Branch of Axillary Nerve
16:55 Distal Dissection and Division of Medial Triceps Branch
18:01 Medial Triceps to Anterior Branch of Axillary Nerve Transfer
Narration: Susan E. Mackinnon
Videography: Andrew Yee
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