Modified Partial Radial to Axillary Nerve Transfer.

Area of Science:

• Orthopedics
• Neurosurgery
• Microsurgery

Background:

• Brachial plexus injuries often result in severe functional limitations, necessitating alternative treatment options.
• Nerve transfers bypass injury zones and reduce regeneration time, making them advantageous over other surgical methods.
• Restoring shoulder function is paramount, making nerve transfer a key consideration for isolated axillary nerve injuries.

Purpose of the Study:

• To describe the technique of partial radial to axillary nerve transfer for restoring shoulder function.
• To highlight the rationale and expected outcomes of this specific nerve transfer procedure.

Main Methods:

• The procedure involves a posterior approach to the proximal humerus with the patient in a lateral decubitus position.
• An intraoperative nerve stimulator identifies a specific radial nerve branch for transfer to the axillary nerve.
• Nerve coaptation is performed using microsurgical techniques with interrupted sutures and fibrin glue, ensuring no tension on the repair site.

Main Results:

• Partial radial to axillary nerve transfer can restore shoulder forward flexion and abduction in cases of persistent axillary nerve paralysis.
• The radial nerve serves as an ideal donor due to synergistic triceps action and often redundant branches.
• Patients undergoing this procedure within 6 months of injury show improved Medical Research Council scores and range of motion.

Conclusions:

• Partial radial to axillary nerve transfer is an effective surgical option for functional recovery of shoulder abduction and flexion.
• The technique offers a solution for patients with severe brachial plexus injuries and functional limitations.
• Early surgical intervention (<6 months) is associated with better patient outcomes.