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MOORE - 2013 ISNR - Innovations of Peripheral Nerve Surgery - Part 2

12/9/2013; Videos embedded with youTube.
by

Andrew Yee

on 28 January 2015

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Transcript of MOORE - 2013 ISNR - Innovations of Peripheral Nerve Surgery - Part 2

Nerve Grafting
Nerve Transfers
Nerve Transfers
for Restoring Function

1
2
3
4
5
2010
2009
2011
Cases per Month
Supercharging
the Injured Nerve

1980
1990
1984
Development of End-to-side in Animal Models
2008
Neuron Cell Body (
Gateway Arch
)
St. Louis, MO
Fairbanks, AK
Adjacent Neuron Fibers
Pronator quadratus flap
for nerve injuries...
1991
Case of AIN to ulnar motor
nerve transfer...
Number of fibers through ETS coaptation...
Retrograde labeling ETS fibers
to dorsal root ganglion (sensory)...
More fibers through larger perineurial window...
Motor ETS axonal sprouting requires injury...
Retrograding labeling ETS fibers
to motor neuron pool (motor)...
No Injury =
Sensory
Sprouting
Injury =
Motor
Sprouting
Types of ETS motor and sensory sprouting...
Spontaneous Collateral
Sprouting -
Sensory
Traumatic Regenerative
Sprouting -
Motor
AIN to ulnar motor nerve transfer...
2002
1996
Publication...
Spring 2009
Reverse ETS Animal Studies
August 2009
First Clinical RETS Surgery
What is a reverse end-to-side...
Regeneration through a RETS coaptation...
Muscle
Anchorage, AK
The RETS thought process...
RETS AIN to ulnar motor nerve transfer...
The 1-year post-operative results...
Benchtop research to clinical...
2011
January 2012
RETS clinical review of cases...
AAHS Presentation

Reverse end-to-side motor nerve
transferfor augmentation of ulnar
nerve intrinsic function.

Barbour JR, Boyd KU, Kale SS,
Bailey M, Mackinnon SE
2013
SETS AIN to ulnar motor nerve transfer
technical paper...
October 2012
2012
SETS in a 2nd/3rd degree nerve injury...
"Supercharge ETS"
"Reverse ETS"
2011-2012
SETS enhances recovery in an
incomplete nerve injury...
March 2013
1996-2008
End-to-end
Nerve Transfer
=
Supercharge
Nerve Transfer
1980
2000
2005
2010
1990
Jumping the Gap
in Spinal Cord Injury

1985
Sensory nerve transfers in paraplegic...
Mackinnon, SE
1993
Feasibility of brachialis branch for transfer...
Brandt, KE
2003
Reinnerating the biceps branch and
brachialis branch...
2005
Double fasciclular nerve transfer...
2007
Tung, TH
Mackinnon, SE
2011
Single Fascicular = Double Fascicular
Carlsen, BT
Single vs double fascicular nerve transfer...
Discussion
Published
Review of cases
of brachialis to AIN nerve transfer...
2008-2010
Ray, WZ
Case of brachialis to AIN nerve transfer
in a spinal cord injury...
2010
Published
2012
Mackinnon, SE
2012
Published
2007
Brachialis to anterior interosseous
nerve transfer...
Results
Pronation and AIN Function - 4 Years
Martin Robson, MD
Brachialis
Nerve
Expendability
Pronation and AIN Function - 2 Years
Median to Radial Nerve Transfer
FCR
Wrist Flexion
Finger Extension
PIN
FDS
Finger Flexion
Wrist Extension
ECRB
Nerve Transfers
I
II
Wrist Drop
Humeral Fractures
Orientation
Lateral Antebrachial Cutaneos Nerve
Radial Vessels Landmark
Step-lengthening Pronator Teres Tendon
Release of Deep Head of Pronator Teres
Arch of Flexor Digitorum Superficialis
Median Nerve Anatomy
Exposure of Radial Nerve
Radial Nerve Anatomy
Median and Radial Nerve
Removal of Supinator Branch
Donr Distal, Recipient Proximal
Median to Radial Nerve Transfers
Median to Radial Nerve Transfers
9 Month Post-operative
1 Year Post-operative
Incision
(N) flexor digitorum superficialis
Donor
(N) posterior interosseous
Recipient
(N) flexor carpi radialis
Donor
(N) extensor carpi radialis brevis
Recipient
radial vessels
(N) radial sensory
(M) pronator teres tendon
(N) flexor digitorum superficialis
Donor
(N) flexor carpi radialis
Donor
(N) posterior interosseous
Recipient
(N) extensor carpi radialis brevis
Recipient
(N) posterior interosseous
Recipient
(N) supinator
(N) flexor digitorum superficialis
Donor
(N) flexor carpi radialis
Donor
(N) posterior interosseous
Recipient
(N) extensor carpi radialis brevis
Recipient
(N) flexor digitorum superficialis
Donor
(N) flexor carpi radialis
Donor
(N) posterior interosseous
Recipient
(N) extensor carpi radialis brevis
Recipient
Radial Nerve Injury
Median and Radial Nerve Anatomy
Nerve Transfers
OLD ANATOMY
CURRENT ANATOMY
Median and Radial Nerve Anatomy
Surgical Procedure
Median and Radial Nerve Anatomy
Post-operative Results
4 Years Post-operative
Median

to
Radial
Nerve Transfer
Median (FCR/FDS)
to
Radial (PIN/ECRB)
Nerve Transfer
Proximal Regenerative Front
Partial Injury Model
2nd/3rd degree injury
Axonotmesis
Supercharge in
Incomplete Model
Partial Injury - Graft
Supercharge Nerve Transfer
Transection
Supercharge in Incomplete Injury
Supercharge in Incomplete Injury
with
Donor

Transection
II.
I.
Additional Regenerative Front
Supercharge Experimental Study
Histomorphometry
End-to-end
Nerve Transfer
Supercharge
Nerve Transfer
=
From Bench-top to Clinic
Innovations of Peripheral Nerve Surgery
October 2013
SETS clinical review of 62 patients...
ASSH
Interfascicular Anatomy of Median Nerve
Interfascicular Anatomy of Median Nerve
Donor
: Brachialis Branch
Recipient
: AIN Fascicle
2 Years Post-Injury
Brachialis to AIN Nerve Transfer
Histomorphometry
Post-operative Results
Functional Recovery - 1 Year
Nerve Fibers: ~3222
Nerve Fibers: ~3512
71 Year-old Male
Spinal Cord Injury: ~C7 Level
Presentation
Pre-operative Examination
Left Arm Examination
Right Arm Examination
2 Years Post-Injury
2 Years Post-Injury
Functional Recovery - 2 Year
LEFT
Brachialis to AIN Nerve Transfer
RIGHT
Electrical Stimulation of Left AIN Fascicle
Electrical Stimulation of Right AIN Fascicle
Melt My Wings
Outcomes
Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO
Nerve Surgery
Credits
Susan E. Mackinnon, MD
Andrew Yee, BS
Peripherial Nerve Surgery Education
nervesurgery.wustl.edu

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

Prezi Presentation
http://prezi.com/user/yeeandrew/
I, Amy M Mmoore, have nothing to disclose.
From Bench-top to Clinic
Innovations of Peripheral Nerve Surgery
Functional Recovery - 3.5 Years
Classification of Nerve Injuries
Nerve Transfers
Supercharge
Nerve Transfers
"NORMAL"
Amy M. Moore, MD
Full transcript