Extended
Authors: Susan Mackinnon , Andrew Yee
Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri, USA
DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.
ABSTRACT
The axillary nerve has several distal branches that provide shoulder function through the innervation of the anterior, middle, and posterior deltoid and teres minor, as well as sensation to the lateral arm. Injury to the axillary nerve has been traditionally viewed as either a complete non-favorable injury where recovery does not occur or a favorable injury where recovery does occur. However, there are situations of mixed injuries where both these scenarios are true, and the axillary nerve has components that will and will not recovery. This mixed nerve injury can be confirmed with the use of electrodiagnostic studies. Management of these cases is to reinnervate the non-recovering components, while protecting the recovering components. The medial triceps branch is an available donor for reconstruction. In this case, the patient suffered an upper brachial plexus injury following a severe fall and lost shoulder function. Electromyography at three months post-injury reported motor unit potentials in the middle and posterior deltoid to recovery, however the anterior deltoid did not have motor unit potentials. Specific reinnervation of the anterior branch of the axillary nerve using the medial triceps branch nerve transfer was elected. This video details the specifics of this nerve transfer.
