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Utility of Denervated Sensory Branch of Radial Nerve as a Graft in Brachial Plexus Reconstruction
Morad Askari, MD1; Michelle, F. Kircher, RN2; Robert J. Spinner, MD3; Allen T. Bishop, MD4; Alexander Y. Shin, MD4
1Div. of Plastic & Reconstructive Surgery/Dept. of Orthopedic Surgery, Div. of Hand Surgery, University of Miami, Miami, FL; 2Neurological Surgery, Mayo Clinic, Rochester, MN; 3Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; 4Orthopedic Surgery, Mayo clinic, Rochester, MN

Introduction: Reconstructive efforts in patient with total brachial plexus injury are in part limited by availability of autologous nerve graft. Ipsilateral sensory branch of radial nerve (SBRN), though denervated due to the injury, may serve as a possible graft donor site, however few if any studies exist that demonstrate its effectiveness.  The purpose of this study was to determine the viability of use of a denervated sensory nerve in motor nerve reconstruction.

Methods: Sixteen patients in whom ipsilateral denervated SBRN was used as a nerve graft in reconstruction of total brachial plexus injury were identified based on availability of pre- and post-operative data with minimum of 12 months of follow up. In all, modified Medical Research Council (mMRC) scale was used to score target muscles before and after surgery. Additionally, electromyography was used post-operatively to assess effectiveness of reconstruction.

Results: SBRN grafts were used to innervate the axillary nerve (3 cases), musculocutaneous nerve (5 cases), and triceps motor branch (8 cases) through various nerve transfers or grafting procedures. Average age of the patients was 32 and average post-operative follow-up period was 18 months. By the last follow-up, 14 of 16 patients had evidence of improvement in targeted muscles. Ten patients had mMRC scores of 2 or greater. Five patients had mMRC scores of 2 or 2+, 3 with score of 3, and 2 with scores of 4 or 4+.  Electromyography results showed improvement in 9 patients but did not correlate well with clinical assessment.

Conclusion: Denervated SBRN can serve as a alternative to intact autologous sources in reconstruction of total brachial plexus injuries.

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