Functional connectivity of the transected brachial plexus after intercostal neurotization in monkeys

Microsurgical reconstructions of brachial plexuses were performed on twelve monkeys by using ipsilateral intercostal nerves (T3-9). Reinnervation in individual nerves was evaluated monthly by observations of neuromuscular and electromyographic improvements. The electromyographic studies revealed reappearance of motor unit potentials. According to a motor scale ranging from 0 to 4, the mean muscle power 6 months after operation improved to 2.75 in the deltoid muscles, 2 in the biceps muscles, 1.22 in the triceps muscles, 1.13 in the flexor carpi radialis muscles, and 1.6 in the intrinsic muscles of the hands. Retrograde transport of horseradish peroxidase (HRP) from the neuromuscular junctions of the reconstructed musculocutaneous nerves 6 months after complete brachial plexus lesion in four animals demonstrated HRP-labeled neurons in the anterior horns, spinal ganglia and sympathetic ganglia of the thoracic spinal cords. It suggested that the regenerated afferent and efferent circuits in the thoracic cords innervating the transected brachial plexuses were able to generate the movements in the paralyzed upper limbs. However, as evidenced by the behavior patterns and the fact that retrograde-labeled neurons were all found in the thoracic cords, the novel movements observed in the reconstructed brachial plexuses were in synchrony with respiration. These results suggested that the plasticity of central neural networks is limited between two widely separated areas, such as between the midcervical and midthoracic motor cortical areas in the present studies, and therefore, the efforts to reconstruct neural networks, both centrally and peripherally, should aim at rebuilding situations as nearly to the original status as possible.