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OLD 2013 WSRM - Video Surgery Nerve Transfers

7/8/2013; Videos embedded in youTube.
by

Andrew Yee

on 10 July 2013

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Transcript of OLD 2013 WSRM - Video Surgery Nerve Transfers

EXAMINATION
SURGICAL INTERVENTION
POST-OPERATIVE OUTCOME
56-year-old male
Previous shoulder and cervical spine surgeries (20-25 years ago)
20-foot fall from a tree
Referred to our institution 8-months following injury

Radial (
+/-
), Median (
+
/
-
), Ulnar (
-
)
Weak EIP, normal PT / FCR with MRC 5
Loss
of ulnar-innervated sensation

MRI lower plexus avulsion
Patient History
Electrical Studies
Operative Planning
Surgical Planning
Pinch and Finger Flexion:
Ulnar Intrinsics:
Brachialis
to
Anterior Interosseous
Nerve Transfer

ECRB
to
Anterior Interosseous
Nerve Transfer

Supinator
to
Anterior Interosseous

Nerve Transfer


Thumb Opposition:
EIP Opponensplasty
EDQ Opponensplasty
FDP Tenodesis
Brachioradialis Tendon Weave to FDP
Distal PIN (EPB/APL) to Ulnar Motor Nerve Transfer
EIP Tendon Transfer for Thumb Adduction
Tung, TH - In development...
EMG
Nerve Conduction Studies
MOTOR
SENSORY
Patient Findings
Median Nerve
C5
C6
C7
C8
T1
Ulnar Nerve
MABC
MBC
Axillary
Radial Nerve
Lower Subscapular
Upper Subscapular
Medial Pectoral
Thoracodorsal
Lateral Pectoral
Musculocutaneous
Spinal Accessory
Subclavius
Suprascapular
Dorsal Scapular
Brachialis to Anterior Interosseous Nerve Transfer
Brachialis to Anterior INterosseous Nerve Transfer
(N) Anterior Interosseous
(N) Pronator Teres
(N) Palmaris Longus
(N) Flexor Carpi Radialis
(N) Brachialis
(N) Lateral Antebrachial Cutaneous
(N) Brachialis
DONOR
(N) Anterior Interosseous
RECIPIENT
Brachialis and Median Nerve Anatomy
Brachialis to Anterior Interosseous Nerve Transfer
Knowledge of anatomy simplifies procedure...
Exposure of Median Nerve
Interfascicular Dissection
of Median Nerve
Exposure of Brachialis Nerve
Brachialis to Anterior Interosseous
Nerve Transfer
Brachialis to Anterior Interosseous Nerve Transfer
Initial
Modified
ECRB to Anterior Interosseous Nerve Transfer
Step-lengthening of
Superficial Head of Pronator Teres
Exposure of Median Nerve
Exposure of Radial Nerve
ECRB to Anterior Interosseous
Nerve Transfer
Brachioradialis Tendon Weave to FDP and FDP Tenodesis
EIP Opponensplasty
Pinch and Grip Strength:
Grip Strength:
Thumb Opposition:
Harvest of Brachioradialis
FDP Tenodesis
Brachioradialis Tendon Weave
Exposure of Adductor Pollicis
Exposure and Harvest of EIP
EIP Opponensplasty
INCISION
INCISION
INCISION
INCISION
Pinch and Finger Flexion:
Grip Strength:
DONOR
RECIPIENT
-outside injury pattern [C5,6,(7)], however deinnervated...
-available proximal donor
-available distal donor
Sensation:
LABC to Ulnar Sensory Nerve Transfer
3rd Webspace to Ulnar Sensory Nerve Transfer
Sensation:
3rd Webspace to Ulnar Sensory Nerve Transfer
NO ULNAR
NO ULNAR
LATERAL CORD INTACT C5,6,7
NO AIN
RECOVERING RADIAL
Classic Lower Plexus C8,T1 Injury
Lower Plexus Injury Examination
Sensory Examination
3rd Webspace (Donor)
II.
Median Sensory
to
Distal 3rd Webspace
Non-critical ETS Nerve Transfer
3rd Webspace (Donor)
and
Ulnar Sensory (Recipient)
Critical ETE Nerve Transfer
I.
3rd Webspace
to
Ulnar Sensory
II.
3rd Webspace
to
Dorsal Cutaneous Ulnar
Non-critical ETS Nerve Transfer
Brachialis to Anterior Interosseous Nerve Transfer
ECRB to Pronator Teres Nerve Transfer
(N) Brachialis
(N) Anterior Interosseous
(N) Flexor Carpi Radialis
(N) Pronator Teres
Nerve Transfer
Anatomy Review
Stimulation Review
Brachialis to AIN Nerve Transfer
Dividing the Donor
Brachialis Nerve
Brachialis to Anterior Interosseous Nerve Transfer
Dividing the Donor Brachialis Nerve
Exposure of Brachialis Nerve
Interfascicular Dissection of Median Nerve
Exposure of Median Nerve
Recipient Fascicle
Step-lengthening of Pronator Teres
ECRB to Anterior Interosseous Nerve Transfer
Exposure of Radial Nerve
Exposure of Median Nerve
LABC to Ulnar Sensory Nerve Transfer
MOTOR
2 YEARS POST-OPERATIVE
5 YEARS POST-OPERATIVE
SENSORY
MOTOR
SENSORY
3rd Webspace to DCU (End-to-side) Nerve Transfer
EIP Opponensplasty
SURGERY
Operation #1
Operation #2
4 YEARS POST-OPERATIVE
2 YEARS POST-OPERATIVE
4 YEARS POST-OPERATIVE
Functional Outcome
Functional Outcome
5 YEARS
5 YEARS
(+)

shoulder, elbow, wrist/finger extension, pronator, FCR
(-)
EPL, finger flexion, AIN, median intrinsics, ulnar ex/intrinsics, ulnar sensation
Pre-operative Examination
VIDEO SURGERY
- NERVE TRANSFERS

Video Surgery - Nerve Transfers
Susan E. Mackinnon, MD

Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO
I, Susan E. Mackinnon, MD, am the co-inventor of the PGA Neurotube and have received research funding from AxoGen Inc.
NIH - 5R01 NS 033406-17
Nerve Allotransplantation for Traumatic Nerve Injury
NIH - 2R01NS05170606A1
The Effects of GDNF on Peripheral Nerve Regeneration
Nerve Surgery
Credits
Andrew Yee, BS
Peripherial Nerve Surgery Education
nervesurgery.wustl.edu

Surgical Video Library
https://vimeo.com/user6062882

Prezi Presentation
http://prezi.com/user/yeeandrew/
FIBs
MUPs
Normal AMP - Root Avulsion
NERVE TRANSFERS
TENDON TRANSFERS
SENSORY TRANSFERS
Sensation:
LABC to Ulnar Sensory Nerve Transfer
PRIORITY
Time Dependent
Donor Distal
,

Recipient Proximal
l
Donor Distal
,

Recipient Proximal
l
Horner's Syndrome
(M) Brachioradialis
(M) FDP I, II
(M) FDP I, II
(M) FDP I, II
(M) Brachioradialis
(M) Extensor indicis proprius
(M) Abductor pollicis brevis
(M) Extensor indicis proprius
(M) Extensor indicis proprius
Full transcript