@article{10.11648/j.ijcems.20200606.17,
  author = {Monica Pecache and Rahul Patil and Raya Abughanmi and Tsu Min Tsai},
  title = {Multi-level Nerve Injury of the Upper Extremity Management and Review of Brachial Plexus Literature: A Case Report},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {6},
  number = {6},
  pages = {149-154},
  doi = {10.11648/j.ijcems.20200606.17},
  url = {https://doi.org/10.11648/j.ijcems.20200606.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20200606.17},
  abstract = {Backround: Brachial plexus injuries are complex cases requiring a thorough understanding of nerve physiology and upper extremity anatomy. Standard approaches and management have been developed but certain situations still arise where these are not feasible options. Objectives: A case of brachial plexus injury is discussed in this report. The patient was a young male who was referred to our center with weakness of the left upper extremity, C5-C7 distribution. Certain components of his injury, such as extensive soft tissue scarring and identification of a long neuroma at the injury site, obliged the surgeons to use unconventional nerve transfers during his surgery. In this paper, we discuss these alternative options in order to support their potential use in complex brachial plexus cases. Other concepts such as single fascicular harvest for nerve transfers and nerve graft augmented nerve transfers are discussed as they were successfully used in this report. Methodology and Results: The patient underwent a total of five surgeries which were a combination of nerve and tendon transfers. Some nerve transfers were augmented with long autologous nerve grafts reaching up to fifteen centimeters in length. Throughout the patients sequence of surgeries, certain nerves, such as the ulnar nerve branch to the flexor carpi ulnaris, successfully served as a donor nerve in more than one occasion. Muscle groups where single nerve fascicles were previously used as a donor nerves also yielded adequate muscle strength and were successfully subsequently used in tendon transfers. Ultimately, the patient was able to achieve good muscle strength, range of motion and outcome scores on his left upper extremity after two years from his final surgery. Conclusion: This report offers multiple alternative options in managing complex brachial plexus cases as well as challenges some concepts in nerve grafting. Alternative donor nerves are offered for transfers, some of which are not previously used in literature. Aside from this, the use of long autologous nerve grafts, single fascicular nerve transfers and repeated use of certain nerves as donor were performed successfully. We hope these procedures and techniques can be added to each hand specialist arsenal for managing complex brachial plexus injuries, specifically when the standard techniques are not feasible.},
 year = {2020}
}

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TY  - JOUR
T1  - Multi-level Nerve Injury of the Upper Extremity Management and Review of Brachial Plexus Literature: A Case Report
AU  - Monica Pecache
AU  - Rahul Patil
AU  - Raya Abughanmi
AU  - Tsu Min Tsai
Y1  - 2020/12/11
PY  - 2020
N1  - https://doi.org/10.11648/j.ijcems.20200606.17
DO  - 10.11648/j.ijcems.20200606.17
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 149
EP  - 154
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20200606.17
AB  - Backround: Brachial plexus injuries are complex cases requiring a thorough understanding of nerve physiology and upper extremity anatomy. Standard approaches and management have been developed but certain situations still arise where these are not feasible options. Objectives: A case of brachial plexus injury is discussed in this report. The patient was a young male who was referred to our center with weakness of the left upper extremity, C5-C7 distribution. Certain components of his injury, such as extensive soft tissue scarring and identification of a long neuroma at the injury site, obliged the surgeons to use unconventional nerve transfers during his surgery. In this paper, we discuss these alternative options in order to support their potential use in complex brachial plexus cases. Other concepts such as single fascicular harvest for nerve transfers and nerve graft augmented nerve transfers are discussed as they were successfully used in this report. Methodology and Results: The patient underwent a total of five surgeries which were a combination of nerve and tendon transfers. Some nerve transfers were augmented with long autologous nerve grafts reaching up to fifteen centimeters in length. Throughout the patients sequence of surgeries, certain nerves, such as the ulnar nerve branch to the flexor carpi ulnaris, successfully served as a donor nerve in more than one occasion. Muscle groups where single nerve fascicles were previously used as a donor nerves also yielded adequate muscle strength and were successfully subsequently used in tendon transfers. Ultimately, the patient was able to achieve good muscle strength, range of motion and outcome scores on his left upper extremity after two years from his final surgery. Conclusion: This report offers multiple alternative options in managing complex brachial plexus cases as well as challenges some concepts in nerve grafting. Alternative donor nerves are offered for transfers, some of which are not previously used in literature. Aside from this, the use of long autologous nerve grafts, single fascicular nerve transfers and repeated use of certain nerves as donor were performed successfully. We hope these procedures and techniques can be added to each hand specialist arsenal for managing complex brachial plexus injuries, specifically when the standard techniques are not feasible.
VL  - 6
IS  - 6
ER  - 

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