Nerve Transfers for Treatment of Isolated Axillary Nerve Injuries

BACKGROUND:

The most common neurological defect in traumatic anterior glenohumeral dislocation is isolated axillary nerve palsy. Most recover spontaneously; however, some have persistent axillary neuropathy. An intact rotator cuff may compensate for an isolated axillary nerve injury; however, given the high rate of rotator cuff pathology with advancing age, patients with an axillary nerve injury are at risk for complete shoulder disability.

OBJECTIVE:

To review reconstruction of the axillary nerve to alleviate shoulder pain, augment shoulder stability, abduction and external rotation to alleviate sole reliance on the rotator cuff to move and stabilize the shoulder.

METHODS:

A retrospective review of 10 patients with an isolated axillary nerve injury and an intact rotator cuff who underwent a triceps nerve branch to axillary nerve transfer was performed. Patient demographics, surgical technique, deltoid strength, donor-site morbidity, complications and time to surgery were evaluated.

RESULTS:

Ten male patients, mean age 38.3 years (range 18 to 66 years), underwent a triceps to axillary nerve transfer for isolated axillary nerve injury 7.4 months (range five to 12 months) post-traumatic shoulder dislocation. Deltoid function was British Medical Research Council grade 0/5 in all patients preoperatively and ≥3/5 deltoid strength in eight patients at final follow-up (14.8 months [range 12 to 25 months]). There were no complications and no donor-site morbidity.

CONCLUSION:

A triceps to axillary nerve transfer for isolated axillary neuropathy following traumatic shoulder dislocation improved shoulder pain, stability and deltoid strength, and potentially preserves shoulder function with advancing age by alleviating sole reliance on the rotator cuff for shoulder abduction and external rotation.     

Nerve grafting

For a long period, nerve grafting was used as a last resort when other means to manage a nerve defect failed. All attempts to apply allografts were disappointing. With the development of a new technique based on microsurgery, free nerve grafting has become a reliable method. The results are close to the results achieved by neurorrhaphy under favorable conditions and better than the results achieved by neurorrhaphy under tension. Today, this fact is recognized by nearly all surgeons. Discussion is limited only to the length of defect that still permits application of neurorrhaphy or represents an indication for nerve grafting. It is logical that different surgeons have different results, according to their training, their background, and the cases they have to treat. If the material contains more fresh cases, neurorrhaphy will be favored; if it contains more late secondary cases, nerve grafts will be applied in a higher frequency. The vascularized nerve graft is a new technique that certainly will have its indication in selected cases. If the immunologic problems connected with nerve grafting will be solved in one or the other way, a new era of nerve grafting will commence.     

Nerve wrapping

Nerve scarring can cause severe pain and dysfunction. Treatment of the scarred nerve frequently yields unpredictable results. A barrier wrap around the scarred nerve could be of benefit in preventing the recurrence of epineural scarring following neurolysis. The barrier would ideally be inert so as to not incite an inflammatory response, and be nondegradable. Veins fulfill both of these objectives. The desirable qualities of a barrier nerve wrap include a substance that decreases nerve scarring, does not constrict and thus compress the nerve, and improves nerve gliding. The primary indication for nerve wrapping is a nerve with adherent scar.     

构建生物人工神经修复周围神经缺损的实验研究

目的：探讨生物人工神经对周围神经再生的作用。方法：用自体雪旺氏细胞、Ⅳ型胶原及可降解的聚乳酸导管构建生物人工神经，桥接10mm缺损的鼠坐骨神经，对照组行自体神经移植，术后8周，2组行大体观察、组织学检查及神经电生理检查。结果：实验组再生神经纤维数、再生轴突恢复率、运动神经传导速度及复合肌肉动作电位振幅均同对照组相近。结论：实验构建的生物人工神经能有效的促进周围神经再生。