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Wu J.-X.,Fudan University | Wu J.-X.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Chen L.,Fudan University | Chen L.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | And 3 more authors.
Journal of Muscle Research and Cell Motility | Year: 2013

There are no biological marks to indicate if denervated muscle atrophy after nerve injury is irreversible. Clinically in obstetric brachial plexus palsy (OBPP), atrophy of denervated intrinsic musculature of the hand is much faster to irreversible than that of denervated muscles of the arm. 64 pup rats whose C5C6 had been divided and C7C8T1 avulsed, were divided equally into the reconstruction and control groups. The former had subgroups R1, R5, R10, R15 where the ulnar and musculocutaneous nerves were reconstructed one, five, ten and 15 weeks respectively after injury and efficacy was evaluated 12 weeks later. The latter had C1, C5, C10, C15 subgroups where denervated muscles of the two nerves were assessed one, five, ten and 15 weeks after injury. Results of average cross-sectional area of the muscle fiber for intrinsic musculature of the forepaw showed that the R5, R10, R15 subgroups were not statistically superior to the C5, C10, C15 ones, respectively, though R1 was; those for biceps indicated, however, that the R1, R5, R10 subgroups were better than the C1, C5, C10 ones, respectively, though R15 was not. In the reconstruction subgroups regenerative nerve fibers in each nerve were no less than 53 percent of those on the control side, while number of motor end plates was statistically less in subgroups with irreversible muscle atrophy. We conclude that rat model of OBPP is suitable for simulating clinical appearance of atrophy of denervated intrinsic musculature of the hand being faster than that of denervated muscles of the arm. © 2012 Springer Science+Business Media Dordrecht.


Rui J.,Mayo Medical School | Rui J.,Fudan University | Runge M.B.,Mayo Medical School | Spinner R.J.,Mayo Medical School | And 4 more authors.
Annals of Plastic Surgery | Year: 2014

Background: Video-assisted gait kinetics analysis has been a sensitive method to assess rat sciatic nerve function after injury and repair. However, in conduit repair of sciatic nerve defects, previously reported kinematic measurements failed to be a sensitive indicator because of the inferior recovery and inevitable joint contracture.Objective: This study aimed to explore the role of physiotherapy in mitigating joint contracture and to seek motion analysis indices that can sensitively ref lect motor function.Methods: Data were collected from 26 rats that underwent sciatic nerve transection and conduit repair. Regular postoperative physiotherapy was applied. Parameters regarding step length, phase duration, and ankle angle were acquired and analyzed from video recording of gait kinetics preoperatively and at regular postoperative intervals.Results: Stride length ratio (step length of uninjured foot/step length of injured foot), percent swing of the normal paw (percentage of the total stride duration when the uninjured paw is in the air), propulsion angle (toe-off angle subtracted by midstance angle), and clearance angle (ankle angle change from toe off to midswing) decreased postoperatively comparing with baseline values. The gradual recovery of these measurements had a strong correlation with the postYnerve repair time course.Conclusions: Ankle joint contracture persisted despite rigorous physiotherapy. Parameters acquired from a 2-dimensional motion analysis system, that is, stride length ratio, percent swing of the normal paw, propulsion angle, and clearance angle, could sensitively ref lect nerve function impairment and recovery in the rat sciatic nerve conduit repair model despite the existence of joint contractures. Copyright © 2014 Lippincott Williams & Wilkins.


Xu B.,Fudan University | Xu B.,Key Laboratory of Hand Reconstruction | Xu B.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Dong Z.,Fudan University | And 8 more authors.
Journal of Reconstructive Microsurgery | Year: 2015

Background In cases of C7-T1 brachial plexus palsy, a reliable method for the reconstruction of the finger and thumb extension was not established until the transfer of the supinator motor branch to the posterior interosseous nerve was proposed. The long-term outcome of this new technique requires evaluation due to the limited number of cases and the shorter follow-up period of the previous study. Objective This study aims to evaluate the long-term effect of the transfer of the supinator motor branch to the posterior interosseous nerve and to determine the recovery time course for this new technique. Methods A retrospective review was conducted in 10 patients with lower brachial plexus injuries who underwent transfer of the supinator motor branch. Patients were followed up postoperatively for a minimum of 24 months, with all patients scheduled to receive a physical examination and electrophysiological testing every 3 months for the first 2 years. Results Nine patients (90%) recovered to the Medical Research Council (MRC) grade 3 or better for the extensor digitorum communis. The electrophysiologically documented recovery began at an average of 5.7 months after surgery, with the average time required for the first finger extension being 9.1 months (range 5-18 months), and the average time required for achieving MRC grade 3 being 14.3 months (range 9-24 months). Moreover, no complications or loss of supination was observed in any patient. Conclusion The supinator motor branch transfer is a safe procedure that yields recovery of finger extension in C7-T1 brachial plexus palsies with encouraging long-term outcomes. © Georg Thieme Verlag KG Stuttgart New York.


Zhang C.-G.,Fudan University | Zhang C.-G.,Key Laboratory of Hand Reconstruction | Zhang C.-G.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Gu Y.-D.,Fudan University | And 2 more authors.
Journal of Brachial Plexus and Peripheral Nerve Injury | Year: 2011

Contralateral C7 nerve transfer has been used in treating brachial plexus avulsion injury since 1986. During the past two and half decades, much has been achieved, yet more needs to be explored. In this review article, the indications, technical details, outcome and pitfalls of this technique are summarized. © 2011 Zhang and Gu; licensee BioMed Central Ltd.


Liu Y.,Fudan University | Liu Y.,Key Laboratory of Hand Reconstruction | Liu Y.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Lao J.,Fudan University | And 5 more authors.
Injury | Year: 2013

Background: The treatment of global brachial plexus avulsion is a demanding field of hand and upper extremity surgery. The recent development of functional and quality-of-life (QOL) assessment tools has improved quantifying these functional outcomes after surgery. Objective: We sought to combine Medical Research Council (MRC) grading with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaires and Numerical Rating Scale (NRS) for pain to evaluate the functional outcome of patients who suffered complete brachial plexus avulsion before and after nerve transfers. Methods: The author carried out a retrospective review of 37 patients with global avulsion of the brachial plexus between 2000 and 2007. All of them underwent nerve transfers in Hua Shan Hospital in Shanghai. They were followed up for over 3 years for physical examination and responding to the questionnaires of DASH, NRS, as well as the satisfaction with the surgery. Results: The mean time to surgery was less than 6 months and the mean follow-up period was 4.59 years (range: 3-9 years). The effective motor recovery rate was 54%, 86%, 46% and 43%, respectively, in supraspinatus, biceps, triceps and finger flexor. Patients who underwent nerve transfers scored consistently better on the DASH score and NRS score than those before surgery. There was also a significant correlation between the change in NRS scores and patient satisfaction. Conclusion: This study validated the effect of nerve transfers for global brachial plexus avulsions from objective MRC grading combining with patients' self-assessments. Neurolysis after neurotisations correlated positively with functional outcomes. © 2012 Elsevier Ltd.


Wang L.,Fudan University | Wang L.,Key Laboratory of Hand Reconstruction | Wang L.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Jiang Y.,Fudan University | And 8 more authors.
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2014

Contralateral C7 (cC7) root transfer to reconstruct brachial plexus injury (BPI) has been widely used. A revised technique that cC7 root was transferred to lower trunk via the prespinal route with direct neurorrhaphy has been reported clinically. The aim of this experimental study was to develop an animal model of the modified surgical approach in order to obtain quantification index of postoperative nerve regeneration and muscle morphology. Sixty adult Sprague-Dawley rats randomized into experimental and control groups of 30 each. In the experimental group, after total brachial plexus injury (BPI) the cC7 root was transferred to lower trunk via the prespinal route with direct neurorrhaphy, and in the control group the brachial plexus was only exposed without intervention. Electrophysiological study, muscle tension test, neuromorphology, muscle wet weight, and muscle fiber cross-sectional area measurements were obtained 4, 8, and 12 weeks postoperatively. Median and ulnar nerve regeneration and the forearm flexor muscles functional recovery were obtained by cC7 root transfer to lower trunk via the prespinal route when measured at 12 weeks following the operation though the parameters had not recovered to normal value. We concealed the control and experimental groups from those who did the evaluations. © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.


Chen L.-Z.,Fudan University | Chen L.-Z.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Chen L.,Fudan University | Chen L.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | And 3 more authors.
Clinical Anatomy | Year: 2013

To elucidate anatomic basis of susceptibility for contracture of the subscapularis muscle in Erb's palsy of the brachial plexus, we semiquantitatively studied the spinal nerve origins of the subscapular nerves innervating the subscapularis, with special reference to the contribution of C7 innervation to the subscapularis. Thirty-three sides of formalin-fixed upper extremities were dissected to obtain the intact brachial plexus. After immersed in 10% acetic acid for 2 weeks, the upper and lower subscapular nerves innervating the whole subscapularis, were dissected retrogradely to verify their spinal nerve origins. The cross-sectional area by C7 innervation and that by the upper trunk innervation was calculated respectively to obtain the constituent percentage of different components in the upper and lower subscapular nerves. In the upper subscapular nerve, fascicles of C7 accounted for 0% (interquartile range, 0-1.1%) of cross-sectional area and those of the upper trunk, 100% (98.9-100%). In the lower subscapular nerve, fascicles of C7 accounted for 40.5% (23.5-47.5%) and those of the upper trunk, 59.5% (52.5-76.5%). In total, 18.6% (13.3-27.3%) of fascicles in the subscapular nerves innervating the subscapularis originated from C7, while 81.4% (72.7-86.7%) of those came from the upper trunk. It is confirmed that innervation of the subscapularis originates from more spinal cord segments than that of infraspinatus and teres minor, and this may be the main reason for which in Erb's palsy, functional recovery of the subscapularis is often faster than that of lateral rotators of the shoulder, resulting in medial rotation contracture of the shoulder. Clin. Anat., 2013. © 2012 Wiley Periodicals, Inc.


Chu B.,Fudan University | Wang H.,Mayo Medical School | Wang H.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Chen L.,Fudan University | And 2 more authors.
Annals of Plastic Surgery | Year: 2016

The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83 of shoulder abduction and 54.00 of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV.


Zhang L.,Fudan University | Zhang L.,Key Laboratory of Hand Reconstruction | Zhang L.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Zhang C.-G.,Fudan University | And 8 more authors.
Neurosurgery | Year: 2012

Background: In injuries of the lower brachial plexus, finger flexion can be restored by nerve or tendon transfer. However, there is no technique that can guarantee good recovery of finger and thumb extension. Objective: To determine the spinal nerve origins of the muscular branches of the radial nerve and identify potential intraplexus donor nerves for neurotization of the posterior interosseous nerve in patients with lower brachial plexus injuries. Methods: An intraoperative electrophysiological study was carried out during 16 contralateral C7 nerve transfers. The compound muscle action potential of each muscle innervated by the radial nerve was recorded while the C5-T1 nerves were individually stimulated. Results: The triceps brachii muscle primarily received root contributions from C7. The C5 and C6 nerve roots displayed greater amplitudes for the brachioradialis and supinator muscles compared with those of the C7, C8, and T1 nerve roots (P < .05). The extensor carpi radialis branch was innervated by C5, C6, and C7, and no significant differences were detected between them (P > .05). The amplitudes obtained for the extensor digitorum communis branch were the largest from C7 and C8, without a significant difference between them (P > .05), whereas the amplitudes of the extensor carpi ulnaris and extensor pollicis longus were largest from the C8 root (P < .05). Conclusion: The supinator muscle branch is likely the best donor nerve for the repair of lower brachial plexus injuries affecting muscles that are innervated by the posterior interosseous nerve.Copyright © 2012 by the Congress of Neurological Surgeons.


Gao K.,Fudan University | Gao K.,Key Laboratory of Hand Reconstruction | Gao K.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Lao J.,Fudan University | And 8 more authors.
Microsurgery | Year: 2013

The treatment of total brachial plexus avulsion injury is difficult with unfavorable prognosis. This report presents our experience on the contralateral C7 (CC7) nerve root transfer to neurotize two recipient nerves in the patients with total BPAI. Twenty-two patients underwent CC7 transfer to two target nerves in the injured upper limb. The patients' ages ranged from 13 to 48 years. The entire CC7 was transferred to pedicled ulnar nerve in the first stage. The interval between trauma and surgery ranged from 1 to 13 months. The ulnar nerve was transferred to recipients (median nerve and biceps branch or median nerve and triceps branch) at 2-13 months after first operation. The motor recovery of wrist and finger flexor to M3 or greater was achieved in 68.2% of patients, the sensory recovery of median nerve area recovered to S3 or greater in 45.5% of patients. The functional recovery of elbow flexor to M3 or greater was achieved in 66.7% of patients with repair of biceps branch and 20% of patients with repair of the triceps branch (P < 0.05). There were no statistical differences in median nerve function recovery at comparisons of the age younger and older than 20-years-old and the intervals between trauma and surgery. In conclusion, the use of CC7 transfer for repair two recipient nerves might be an option for treatment of total BPAI. The functional recovery of the repaired biceps branch appeared to be better than that of the triceps branch. © 2013 Wiley Periodicals, Inc.

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