gms | German Medical Science

Objectives/Interrogation: Brachial plexus injury is an entity that frequently affects the young population with a low incidence, but with a great impact on functionality and quality of life. Despite advances in reconstruction techniques, the treatment of this lesion remains difficult, requiring more research and development of new techniques that allow optimizing results. Our objective is to describe a surgical technique based on the transfer of median nerve's fascicles to the axillary nerve and its anatomical characterization.

Methods: the anatomical bases and the surgical technique were described in cadavers with subsequent implementation in a patient with brachial plexus lesion at the upper primary trunk level, previous informed consent and consecutive clinical follow-up.

Results: Brachial plexus exploration was performed on five cadavers, identifying axillary nerve and median nerve. By intrafascicular dissection of the median nerve, the transfer is performed to the axillary nerve without any tension. This technique is applied in a selected patient with upper brachial plexus injury, through an axillary approach. Two years of follow-up, it found to be reinnervation of the deltoid muscle with functionality of 110º for shoulder abduction and 90º for external rotation.

Conclusion: As described in this technique the use of the fascicles of the median nerve for the transfer to the axillary nerve is an anatomically possible option to improve shoulder abduction in combination with spinal accessory nerve transfer to suprascapular nerve in patients with upper segments brachial plexus injuries, its benefit should be compared with techniques so far described.