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Brachialis to Anterior Interosseous Nerve Transfer: Comprehensive Anatomic Rationale
Olga Politikou1,2, Leopold Harnoncourt1, Fabian Fritsch1
1Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna , Austria.
Operative Neurosurgery (Hagerstown, Md.)
|September 9, 2024
Summary
The brachialis to anterior interosseous nerve (BrAIN) transfer shows inconsistent results due to nerve interconnections. Variability in the median nerve
Area of Science:
- Neuroscience
- Surgical Anatomy
- Reconstructive Surgery
Background:
- Nerve transfers are crucial for restoring function after neurological injuries.
- The brachialis to anterior interosseous nerve (BrAIN) transfer aids in prehension reanimation for brachial plexus and spinal cord injuries.
Purpose of the Study:
- To investigate the reasons behind inconsistent outcomes in BrAIN transfer procedures.
- To analyze the intraneural topography and fascicular interconnections of the median nerve relevant to the BrAIN transfer.
Main Methods:
- Conducted anatomical dissections on 30 upper limb specimens.
- Examined the intraneural topography of the median nerve at the BrAIN transfer site.
- Identified fascicular interconnections between the anterior interosseous nerve and other median nerve branches distally.
Main Results:
- Consistently observed fascicular interconnections between the anterior interosseous nerve and other median nerve branches in the distal upper arm.
- Documented varying intraneural topography of the anterior interosseous nerve at the transfer level (dorsomedial, dorsolateral, dorsal).
- Located fascicular interconnections at specific distances proximal to the interepicondylar line (3.85 ± 1.82 cm and 9.45 ± 1.16 cm).
Conclusions:
- The presence of consistent fascicular interconnections and variable intraneural topography of the median nerve may contribute to aberrant reinnervation after BrAIN transfer.
- Understanding these anatomical variations is critical for improving surgical outcomes in nerve transfer procedures.
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