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FDS to Pronator Teres Nerve Transfer
FCR to Pronator Teres Nerve Transfer
Results of Nerve Transfers
Thoracodorsal to Axillary
Nerve Transfer
Medial Pectoral to Musculocutaneous
Nerve Transfer
Classification of Nerve Injuries
Results of Nerve Grafting
Nerve Transfers
Fairbanks, AK
St. Louis, MO
Anchorage, AK
Nerve Injury and Recovery
St. Louis, MO
Anchorage, AK
Nerve Anatomy
(+)
Distance Time
Time Muscle
Muscle Function
Supercharge
Nerve Transfers
Credits
Comprehensive Review of Neurosurgery
Andrew Yee, BS
Acute Nerve Injury and Repair
(+)
Part II - Supercharge Nerve Transfers and Nerve Transfers in the Hand
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
Susan E. Mackinnon, MD
Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO
Peripherial Nerve Surgery Education
nervesurgery.wustl.edu
Surgical Video Library
https://vimeo.com/user6062882
Prezi Presentation
http://prezi.com/user/yeeandrew/
Nerve Transfers
Indications
Nerve Transfer provides:
Supercharging the Injured Nerve
Supercharge
End-to-side
Clinical
Research
Supercharge Nerve Transfer
Ulnar Nerve Injury
End-to-end
Fairbanks, AK
Clawing
2nd / 3rd Degree Nerve Injury
(Axonotmesis)
Post-operative Outcome
Orientation
Anchorage, AK
St. Louis, MO
Revision Ulnar Nerve Transposition
Supercharge AIN to Ulnar Motor Nerve Transfer
Guyon's Canal Release
2 Years
Proximal Regenerative Front
1st Dorsal Interosseous Wasting
Right - 23/102
Right - 3/58
Functional Results
Muscle Force Analysis
DONOR - Anterior Interosseous Nerve
Post-operative
Pre-operative
Partial Injury Model
Supercharge in
Incomplete Injury
Transection
Specific Force (N/cm2)
Supercharge in Incomplete Injury
Partial Injury
Supercharge
Partial Injury
Supercharge
Supercharge in Incomplete Injury
with Donor Transection
RECIPIENT - Ulnar Motor Fascicle
Supercharge
Anterior Interosseous to Ulnar Motor Nerve Nerve Transfer
Additional Regenerative Front
Supercharge Experimental Study
Transgenic Animal Models
Nerve Transfers
Supercharge
Nerve Transfer
End-to-end
Nerve Transfer
=
Brachialis to Anterior Interosseous Nerve Transfer
Brachialis to AIN / PT Nerve Transfer
Post-operative Results
Pronation and AIN Function - 4 Years
Pronation and AIN Function - 2 Years
SCI Brachialis to Anterior Interosseous Nerve Transfer
Melt My Wings
Post-operative Results
Functional Recovery - 1 Year
Restoration of AIN Function in SCI Patient
Spinal Cord Injury: ~C7 Level
71 Year-old Male
2 Years Post-Injury
Left - Brachialis to AIN Nerve Transfer
Right - Brachialis to AIN Nerve Transfer
Interfascicular Anatomy of Median Nerve
Electrical Stimulation of Right AIN Fascicle
Electrical Stimulation of Left AIN Fascicle
Interfascicular Anatomy of Median Nerve
Histomorphometry
Recipient: AIN Fascicle
2 Years Post-Injury
Donor: Brachialis Branch
Nerve Fibers: ~3512
Nerve Fibers: ~3222
Pre-operative Examination
Left Arm Examination
Right Arm Examination
Median to Radial Nerve Transfer
Outcomes
Surgical Procedure
Outcomes
Radial Nerve Injury
Median to Radial Nerve Transfers
Incision
Median (FCR / FDS) to Radial (PIN / ECRB) Nerve Transfer
Lateral Antebrachial Cutaneos Nerve
Nerve Transfers
4 Year Post-operative
Radial Vessels Landmark
(M) pronator teres tendon
(N) radial sensory
Humeral Fractures
Wrist Drop
radial vessels
9 Month Post-operative
FCR
PIN
Nerve Transfers
Median and Radial Nerve Anatomy
Step-lengthening Pronator Teres Tendon
Release of Deep Head of Pronator Teres
FDS
ECRB
Arch of Flexor Digitorum Superficialis
Median Nerve Anatomy
Median to Radial Nerve Transfers
(N) flexor digitorum superficialis
(N) flexor carpi radialis
Exposure of Radial Nerve
1 Year Post-operative
Radial Nerve Anatomy
Median and Radial Nerve Anatomy
(N) posterior interosseous
(N) extensor carpi radialis brevis
Median and Radial Nerve
(N) posterior interosseous
(N) extensor carpi radialis brevis
(N) flexor digitorum superficialis
(N) flexor carpi radialis
Removal of Supinator Branch
(N) posterior interosseous
(N) supinator
Donr Distal, Recipient Proximal
Orientation
(N) extensor carpi radialis brevis
(N) posterior interosseous
(N) flexor digitorum superficialis
(N) flexor carpi radialis
Median to Radial Nerve Transfers
(N) posterior interosseous
(N) extensor carpi radialis brevis
(N) flexor carpi radialis
(N) flexor digitorum superficialis
ECRB to Anterior Interosseous Nerve Transfer
ECRB to Pronator Teres Nerve Transfer
(N) extensor carpi radialis brevis
(N) extensor carpi radialis brevis
(N) extensor carpi radialis brevis
(N) extensor carpi radialis brevis
(N) anterior interosseous
(N) extensor carpi radialis brevis
(N) anterior interosseous
(N) anterior interosseous
(N) pronator teres
(N) pronator teres
Supinator to Anterior Interosseous Nerve Transfer
Complete Median Nerve Injury
(N) pronator teres
(N) flexor digitorum superficialis
(N) flexor digitorum superficialis
(N) pronator teres
(N) pronator teres
(N) flexor digitorum superficialis
FDS to Anterior Interosseous Nerve Transfer
AIN Palsy
(N) anterior interosseous
(N) anterior interosseous
(N) anterior interosseous
(N) flexor digitorum superficialis
(N) flexor digitorum superficialis
(N) flexor digitorum superficialis
FCU to Pronator Teres Nerve Transfer
FDS to FPL Nerve Transfer
Pre-operative Examination
Post-operative Results
(N) anterior interosseous
(N) flexor pollicis longus
(N) remaining anterior interosseous
(N) flexor digitorum superficialis
(N) flexor digitorum superficialis
(N) flexor pollicis longus
(N) flexor digitorum superficialis
Anterior Interosseous (PQ) to Recurrent Thenar Nerve Transfer with Graft
Anterior Interosseous (PQ) to Ulnar Motor Nerve Transfer
Post-operative Results
Adjunct Procedures
FDP Tenodesis
Guyon's Canal Release with Deep Motor Branch
Nerve Transfer
Donor Anterior Interosseous Nerve (PQ)
Recipient Proximal
Recipient Ulnar Motor Component
Nerve Transfer
(N) ulnar sensory component
(N) 3rd webspace of median
(N) ulnar motor component
(N) ulnar sensory component
(N) anterior interosseous (PQ)
(N) ulnar sensory component
(N) ulnar motor component
(N) ulnar motor component
(N) anterior interosseous (PQ)
(N) dorsal cutaneous branch of ulnar
Restoration of Hand Function
LABC to Radial Sensory Nerve Transfer
3rd Webspace to Ulnar Sensory Nerve Transfer
3rd Webspace to Dorsal Cutaneous Ulnar
3rd Webspace to Ulnar Sensory
Non-critical ETS Nerve Transfer
Critical ETE Nerve Transfer
Median Sensory to Distal 3rd Webspace
3rd Webspace (Donor) and Ulnar Sensory (Recipient)
3rd Webspace (Donor)
Non-critical ETS Nerve Transfer
DCU to Critical Median Sensory Nerve Transfer
Ulnar Sensory to 3rd Webspace
Dorsal Cutaneous Ulnar (Donor) and 1st and 2nd Webspace (Recipient)
Ulnar Sensory to 1st and 2nd Webspace
Ulnar Sensory to Distal Dorsal Cutaneous Ulnar
Critical ETE Nerve Transfer
Non-critical ETS Nerve Transfer
3rd to 1st Webspace Nerve Transfer
Ulnar Sensory to Distal 3rd Webspace
3rd Webspace to 1st Webspace
3rd Webspace (Donor) and 1st Webspace (Recipient)
Critical ETE Nerve Transfer
Non-critical ETS Nerve Transfer
Restoration of Hand Sensation
Sensory Transfers Summary
Sensory Nerve Transfers
Early Sensory Nerve Transfers
End-to-end (ETE) vs End-to-side (ETS)
Restoration of 1st Webspace
Restoration of 2nd / 3rd Webspace
Restoration of Ulnar Nerve Sensation
Perineurial Window
ETS Neurorrhaphy
Spontaneous Collateral Sprouting
Larger perineurial window induces greater collateral sprouting.
Total Fiber Number
Pannucci C, et al . End-to-side nerve repair: review of the literature. Restor Neurol Neurosci. 25:45-63, 2007.
Radial Nerve
Pronator Teres Nerve
Anterior Interosseous Nerve of Median Nerve
Flexor Pollicis Longus of Median Nerve
Recurrent Thenar Branch of Median Nerve
Deep Motor Branch of Ulnar Nerve
C5, C6 Palsy
Median Nerve
Ulnar Nerve
Radial Nerve