Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 45:
Direct Surgery of Traumatic Lesions of the Brachial Plexus
 
  FIG. 45-02. Rupture of C5 with intradural avulsion of C6. C5 is grafted to the suprascapularis nerve and to the fascicular bundles going to the lateral cord. If the root contains enough fascicles, two grafts will be directed toward the upper origin of the posterior cord. With this type of lesion, it is necessary to perform a neurolysis of the C7 root.


FIG. 45-03. Intradural avulsion of the C5 and C6 root. The biceps nerve is neurotized by the spinal accessory nerve. An alternate solution is to neurotize the suprascapularis nerve by the spinal accessory nerve and to neurotize the biceps nerve by three intercostal nerves.


FIG. 45-04. Rupture of the C5, C6, and C7 roots. A graft connects C5 to the suprascapularis nerve. The remaining fibers of C5 are directed toward either the upper trunk or the lateral cord. The C6 root is directed in priority toward the posterior plane of the plexus.


FIG. 45-05. Rupture of the C5 and C6 with intradural avulsion of C7. C5 is grafted to the suprascapularis nerve and to the fascicular bundles going to the lateral cord. C6 is grafted preferentially to the posterior plane. Because the fibers of the C7 root have a spread-out distribution in the brachial plexus, this root is not usually used for neurotization.


FIG. 45-06. Rupture of C5 with intradural avulsion of C6 and C7. The spinal accessory nerve is neurotized with the suprascapularis nerve. C5 is grafted to the musculocutaneous nerve or to the lateral cord.

 


FIG. 45-07. Intradural avulsion of C5, C6 and C7, C8 and T1 being intact. The biceps nerve is neurotized by the spinal accessory nerve. An alternate solution is to neurotize the supraspinatus nerve by the spinal accessory nerve and the biceps nerve by the intercostal nerves.


FIG. 45-08. Intradural avulsion of the C5, C6, and C7 roots in a 6-year-old child who was in a car accident. The biceps nerve has been neurotized by the spinal accessory nerve. Two saphenous nerve grafts, 6 cm long, connect the extremities of the nerves.


FIG. 45-09. Results 9 months after neurotization. Elbow flexion is at M3+.


FIG. 45-10. The hand and finger extension deficit was corrected by a double-tendon transfer.


FIG. 45-11. Rupture of C5 and C6 with intradural avulsion of C7, C8 and T1. C5 is grafted to the suprascapularis nerve and also to the musculocutaneous nerve or to the lateral cord. If the root contains enough fascicles, one or more grafts will be directed toward the posterior plane of the upper part of the brachial plexus. To maintain an acceptable trophic condition, C8 is neurotized by three intercostal nerves.


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