Nerve Transfers Flashcards
Major indications for nerve transfer
Proximal nerve stump not available
Distance to target is prohibitive to recovery
The timeline of muscle atrophy must still be respected with nerve transfers except in wich condition?
Sensory nerve transfers and tetraplegia transfers
types of nerve
transfers
End-to-end (he called copulation)
End-to-side (he called inoculation)
reverse end-to-side supercharge
Partial nerve transfers of up to 30% Abspaltung
Muscles will atrophy if not reinnervated within 12 to 18 months
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The prognosis for sensory recovery likely declines over time
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recovering nerve may
be utilized. In devastating multinerve injuries or cervical spinal cord
injuries
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regeneration
of only 12% to 30% ofthe native axons leads to motor function equivalent to preinjury function
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donor nerves with over 74%
the number ofaxons in the target nerve led to improved outcomes in
cross-facial nerve grafts for facial palsy
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n patients with injury to the musculocutaneous nerve and loss of elbow flexion what are the options?
flexor digitorum superficialis (FDS) branch or a fascicle of flexor carpi ulnaris (FCU) to transfer· to the biceps
In case of prevous question why do we prefer to use the ulnar nerve rather than median
Considering that the
biceps is a supinating muscle and that the median nerve controls pronation,
initial retraining following intercostal nerve transfers to the biceps,
the patient must learn to inhale to initiate elbow flexion
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, full voluntary control is possible irrespective of breathing
patterns
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The children need special training for cortical reeducation
F Excellent cortical plasticity in children often enables the motor
reeducation of the transferred nerve without learned tricks
It may be intuitive to place the repair
distal on the recipient nerve to shorten the distance to the target, but
a repair with excessive tension risks poor outcomes
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The most significant advantage
of ETS is that donor morbidity is minimized
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ETS is useful when donor nerves are scarce نادر
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ETS transfers have been increasingly used to reconstruct
birth-related brachia! plexus injuries
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reverse ETS or supercharge ETS
indicates leaving the
recipient nerve intact and coapting the proximal end of the donor
nerve to the side of the recipient nerve
Indications of reversend to side?
a large mixed motor and sensory nerve is injured proximally
partial nerve injuries. For example,
in a partial ulnar injury where electrodiagnostic studies indicate axons
in continuity to muscles, but severely reduced in number
both sensory and motor nerves can be utilized to preserve muscle mass.
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Facial muscle has short reinnervation window
F Facial muscle differs from skeletal muscle and is
thought to have a longer reinnervation window, considered to be
up to 12 to 24 months after injury
Two of the most integral movements for facial function are
eye closure and smile,
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The most common nerve transfer in the face
Nerve to masseter
advantages of the masseteric nerve
■ Robust axonal supply
■ Ability to be transferred without a graft
■ Reliable location
■ Low donor site morbidity
Use
of the masseteric nerve typically results in less spontaneous and emotional movement,
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n adults who have had smile movement
powered by the masseteric nerve, 85% achieve the ability to smile without biting
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smile spontaneity occurring routinely in 59%with the masseteric nerve
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hypoglossal nerve has yielded
greater results with respect to resting tone compare with masseteric one
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Differential innervation of separate facial movements candecrease
unnatural mass movements or unwanted synkinetic movements.
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