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Restoration of shoulder abduction function by direct muscular neurotization with the phrenic nerve fascicles and nerve grafts: A case report
Author(s) -
Sinis Nektarios,
Boettcher Michael,
Werdin Frank,
Kraus Armin,
Schaller HansEberhard
Publication year - 2009
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.20651
Subject(s) - medicine , axillary nerve , phrenic nerve , reinnervation , deltoid curve , brachial plexus , biceps , deltoid muscle , brachial plexus injury , surgery , suprascapular nerve , intercostal nerves , musculocutaneous nerve , anatomy , accessory nerve , respiratory system
In this report, we describe the first case of using the partial phrenic nerve transfer and direct muscular implantation into the deltoid muscle for restoration of the shoulder function and stability. A patient suffering from the partial brachial plexus injury with absent axillary nerve underwent reconstructive surgery by an end‐to‐end nerve coaptation using two fascicles of the phrenic nerve and two autologous nerve grafts, and direct implantation of nerve grafts into the deltoid muscle. Eighteen months after the procedure, we found a functioning biceps with 90° elbow flexion against gravity and 40° shoulder abduction with satisfactory shoulder stability. Electrophysiology revealed reinnervation potentials in the deltoid and biceps muscle. This case demonstrates a satisfactory result after using transfer of the partial ipsilateral phrenic nerve in combination with muscular implantation to restore shoulder abduction and stability. We recommend the described techniques in cases without other reconstructive options. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.