For the Medical Practitioners
doi: 10.25005/2074-0581-2022-24-1-123-131
NERVE TRANSFER IN IRREVERSIBLE INJURIES OF UPPER LIMB NERVE: CURRENT KNOWLEDGE AND FUTURE PERSPECTIVE

G.M. Khodzhamuradov1, R.N. Berdiev2, A.A. Davlatov1,3, Kh.I. Sattorov1, M.F. Odinaev1, B.А. Odinaev3

1Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
2Department of Neurosurgery, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
3Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To share the experience of using nerve transfer in the irreparable upper limb nerve damage.

Methods: An analysis was made of various transfers (neurotization surgery) in 32 patients with upper limb nerve damage aged 22 to 59 years (27 males, 5 females). Nerve injuries were localised at the level of the forearm (18), shoulder (11) and brachial plexus (3). Surgical repair was aimed at restoring sensitivity and movement in 22 and 10 cases, respectively. For sensitive neurotization, the cutaneous branches of the radial nerve (RN), the dorsal branch of the ulnar nerve (UN), the superficial branch of the UN, and the cutaneous nerves of the forearm were more often used. Motor neurotization was achieved using the branches of the anterior interosseous nerve (AIN), thoracodorsal nerve (TDN), muscular branches of the UN, intercostal nerves (ICNs), and terminal and muscular branches of the brachial and cervical plexuses, respectively.

Results: Long-term outcomes were evaluated between years 1 and 8. Sensitivity was restored to S3 grade (protective sensitivity), and motor strength reached M3-M4 grades according to British Medical Research Council (MRC) scale.

Conclusion: Nerve transfer in irreparable nerve damage allows expanding the boundaries of reconstructive surgery. Furthermore, it opens new horizons for future scientific research to improve modern surgical treatment concepts of peripheral nerve injuries.

Keywords: Upper limb nerve injury, irreparable damage to the upper limb nerves, neurotization, nerve displacement, nerve transfer.

Download file:

References
  1. Bekhterev AV, Tkachenko SA, Mashtalov VD. Taktika pri povrezhdeniyakh nervov verkhney konechnosti [Tactics for injuries of the nerves of the upper limb]. Glavnyy vrach yuga Rossii. Travmatologiya, neyrokhirurgiya. 2017;57(4):28-32.
  2. Korotchenko EN, Semyonova ZhB. Selektivnaya nevrotizatsiya sredinnogo nerva u molodykh patsientov s oslozhnyonnoy pozvonochno-spinnomozgovoy travmoy na urovne CV-CVII [Selective neurotization of the median nerve in young patients with complicated spinal cord injury at the level of CV-CVII]. Voprosy neyrokhirurgii imeni N.N. Burdenko. 2020;84(6):59-66. Available from: https://doi.org/10.17116/neiro20208406159
  3. Gorbunov NS, Kober KV, Protasyuk YeN, Rostovtsev SI, Samotyosov PA. Anatomicheskoe obosnovanie transpozitsii grudospinnogo nerva pri nevrotizatsii povrezhdyonnykh nervov plechevogo spleteniya [Anatomical substantiation of the transposition of the thoracodorsal nerve in case of neurotization of damaged nerves of the brachial plexus]. Byulleten' sibirskoy meditsiny. 2021;20(1):31-8. Available from: https://doi.org/10.20538/1682-0363-2021- 1-31-38
  4. Chuang DC. Distal nerve transfer: Perspective of reconstructive microsurgery. J Reconst Microsurg. 2018;34(9):675-7. Available from: https://doi. org/10.1055/s-0038-1639369
  5. Domeshek LF, Novak CB, Patterson JM, Hasak JM, Yee AB, Kahn LC. Mackinnon SE. Nerve transfers – a paradigm shift in the reconstructive ladder. Plastic and Reconstructive Surgery - Global Open. 2019;7(6):e2290. Available from: https://doi.org/10.1097/GOX.0000000000002290
  6. Ding W, Li X, Pan J, Zhang P, Yin S, Zhou X, et al. Repair method for complete high ulnar nerve injury based on nerve magnified regeneration. Therapeutics and Clinical Risk Management. 2020;16:155-68.
  7. Khodzhamuradov GM. Operatsii nevrotizatsii pri nevosstanovimykh defektakh nervnykh stvolov verkhnikh konechnostey [Operations of neurotization for irreparable defects of the nerve trunks of the upper extremities]. Rossiyskiy mediko-biologicheskiy vestnik imeni akademika I.P. Pavlova. 1012;4:118-22.
  8. Karamanos E, Rakitin I, Dream S, Siddiqui A. Nerve transfer surgery for penetrating upper extremity injuries. Perm J. 2018;22:17-156. Available from: https://doi.org/10.7812/TPP/17-156
  9. Bergmeister KD, Schönle P, Böcker AH, Kronlage M, Godel T, Daeschler S. Improved diagnostics and therapeutic decision making in traumatic peripheral nerve lesions using MR-neurography. Handchir Mikrochi. Plas. Chir. 2018;50(4):232-40. Available from: https://doi.org/10.1055/s-0044-101833
  10. Chuang DC. Distal nerve transfer: Perspective of reconstructive microsurgery. J Reconst Microsurg. 2018;34(9):675-7. Available from: https://doi. org/10.1055/s-0038-1639369
  11. Emamhadi M, Andalib S. The first experience of triple nerve transfer in proximal radial nerve palsy. World Neurosurg. 2018;109:351-5. Available from: https://doi.org/10.1016/j.wneu.2017.10.033
  12. Foroni L, Siqueira MG, Martins RS, Oliveira GP. The intercostobrachial nerve as a sensory donor for hand reinnervation in brachial plexus reconstruction is a feasible technique and may be useful for restoring sensation. Arq Neuropsiquiatr. 2017;75(7):439-45. Available from: https://doi.org/10.1590/0004- 282X20170073
  13. Kaiser R, Waldauf P, Haninec P. Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents. Acta Neurochirurgica (Wien). 2012;154(7):1293-7. Available from: https://doi.org/10.1007/s00701- 012-1291-7
  14. Malalasekera A, Beneragama T, Kanesu S, Sahathevan V, Jayasekara R. Extra and intramuscular distribution of the thoracodorsal nerve with regard to nerve reconstruction surgeries. J Reconstr Microsurg. 2016;32(5):358-60. Available from: https://doi.org/10.1055/ s-0036-1579541
  15. Zhuravlyov SA, Golubev IO. Varianty nevrotizatsiy pri povrezhdeniyakh plechevogo spleteniya i nervov verkhney konechnosti. Obzor literatury [Variants of neurotization in injuries of the brachial plexus and nerves of the upper limb. Literature review]. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2015;4:77-82.
  16. Morris M, Brogan DM, Boyer MI, Dy CJ. Trends in nerve transfer procedures among board-eligible orthopedic hand surgeons. Journal of Hand Surgery Global Online. 2021;3:24-9.
  17. Malikov MKh, Khasanov MA, Mirzobekov KhF, Sattorov KhI. Nekotorye aspekty diagnostiki i khirurgicheskogo lecheniya povrezhdeniy nervnykh stvolov verkhney konechnosti [Some aspects of diagnosis and surgical treatment of injuries of the nerve trunks of the upper limb]. Vestnik Avitsenny [Avicenna Bulletin]. 2020;22(4):613-9. Available from: https://doi.org/10.25005/2074-0581-2020- 22-4-613-619.

Authors' information:

Khodzhamuradov Gafur Mukhammadmukhsinovich
Doctor of Medical Sciences, Leading Researcher of the Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: F-4112-2018
ORCID ID: 0000-0002-7095
SPIN: 1726-7169
E-mail: gafur@tojikiston.com

Berdiev Rustam Namozovich
Doctor of Medical Sciences, Full Professor, Head of the Department of Neurosurgery, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-4804-1931
Author ID: 909287
SPIN: 6410-5833
E-mail: rnamozzoda@mail.ru

Davlatov Abdumalik Abdulkhakovich
Candidate of Medical Sciences, Hospital Resident of the Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery; Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: AAF-6440-2022
Scopus ID: 21933830600
ORCID ID: 0000-0003-2776-074X
SPIN: 3766-9641
Author ID: 998715
E-mail: davlatov.abdumalik@mail.ru

Sattorov Khabibullo Izatulloevich
Postgraduate Student, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0002-2891-0570
E-mail: habibullo.sattorov0009@mail.ru

Odinaev Mirali Fayzulloevich
Hospital Resident of the Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: С-5172-2019
ORCID ID: 0000-0002-5361-1724
SPIN: 5388-9704
E-mail: mirali67@mail.ru

Odinaev Bakhodur Avezovich
PhD Student, Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-9613-2467
SPIN: 4147-6409
E-mail: medicodinaev@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from companies manufacturing medications and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Khodzhamuradov Gafur Mukhammadmukhsinovich
Doctor of Medical Sciences, Leading Researcher of the Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery

734003, Republic of Tajikistan, Dushanbe, Sanoi str., 33

Tel.: +992 (918) 421194

E-mail: gafur@tojikiston.com

Materials on the topic:
  1. CHALLENGES IN THE DIAGNOSTICS AND TREATMENT OF DUODENUM INJURIES IN CHILDREN
  2. DELAYED RECONSTRUCTIVE SURGERY FOR SEVERE HAND INJURIES
  3. SURGICAL MANAGEMENT OF POST-BURN SCAR EXTENSION CONTRACTURES OF THE TOES
  4. GIANT FRONTOETHMOIDAL OSTEOMAS: A RATIONAL APPROACH TO THE SURGICAL REMOVAL AND THE IMMEDIATE RECONSTRUCTION OF THE ANTERIOR WALL OF THE FRONTAL SINUS
  5. THE LATISSIMUS DORSI MUSCLE FLAP TRANSFER IN SURGICAL CORRECTION OF POST-TRAUMATIC UPPER LIMB DYSFUNCTION
  6. SURGICAL REPAIR OF LATERAL AND ANTEROLATERAL HERNIAS OF THE ABDOMINAL WALL
  7. RESULTS OF LAPAROSCOPIC AND CONVENTIONAL HERNIOPLASTY IN OLDER PATIENTS AND MORPHOLOGICAL CHANGES IN THE TISSUES OF THE INGUINAL CANAL
  8. IMMEDIATE RESULTS OF URETROPLASTY IN DIFFERENT FORMS OF HYPOSPADIAS
  9. ANALYSIS OF THE EFFICIENCY OF APPLICATION OF THE TWO SURGERY METHODS OF TREATMENT OF THE URETHRAL INJURY CONSEQUENCES
  10. THE OUTCOMES OF THE FOREARM FLAP APPLICATIONS IN THE UPPER LIMB SEVERE INJURIES RECONSTRUCTION

◄ Back to the list