Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(07): 439-445
DOI: 10.1590/0004-282X20170073
ARTICLES

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

O uso do nervo intercostobraquial como doador na restauração cirúrgica da sensibilidade da mão em lesões do plexo braquial é uma técnica anatomicamente viável e pode ser útil para a recuperação sensitiva
Luciano Foroni
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurocirurgia, São Paulo SP, Brasil;
,
Mário Gilberto Siqueira
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurocirurgia, São Paulo SP, Brasil;
,
Roberto Sérgio Martins
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurocirurgia, São Paulo SP, Brasil;
,
Gabriela Pintar Oliveira
2   Universidade de São Paulo, Faculdade de Medicina, São Paulo SP, Brasil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Objective

Few donors are available for restoration of sensibility in patients with complete brachial plexus injuries. The objective of our study was to evaluate the anatomical feasibility of using the intercostobrachial nerve (ICBN) as an axon donor to the lateral cord contribution to the median nerve (LCMN).

Methods

Thirty cadavers were dissected. Data of the ICBN and the LCMN were collected, including diameters, branches and distances.

Results

The diameters of the ICBN and the LCMN at their point of coaptation were 2.7mm and 3.7mm, respectively. The ICBN originated as a single trunk in 93.3% of the specimens and bifurcated in 73.3%. The distance between the ICBN origin and its point of coaptation to the LCMN was 54mm. All ICBNs had enough extension to reach the LCMN.

Conclusion

Transfer of the ICBN to the LCMN is anatomically feasible and may be useful for restoring sensation in patients with complete brachial plexus injuries.

RESUMO

Objetivo

Poucos doadores estão disponíveis para a restauração da sensibilidade em pacientes com lesões completas do plexo braquial (LCPB). O objetivo deste estudo foi avaliar a viabilidade anatçmica do uso do nervo intercostobraquial (NICB) como doador de axçnios para a contribuição do cordão lateral para o nervo mediano (CLNM).

Métodos

Trinta cadáveres foram dissecados. Os dados do NICB e do CLNM foram coletados: diâmetros, ramos e distâncias.

Resultados

Os diâmetros do NICB e da CLNM no ponto de coaptação foram 2,7mm e 3,7mm, respectivamente. O NICB originou-se como um único tronco em 93,3% dos espécimes e bifurcou-se em 73,3%. A distância entre a origem do NICB e seu ponto de coaptação com a CLNM foi de 54mm. Todos os NICBs tiveram extensão suficiente para alcançar a CLNM.

Conclusão

A transferência do NICB para a CLNM é anatomicamente viável e pode ser útil para restaurar a sensibilidade em pacientes com LCPB.

brachial plexus - intercostal nerves - median nerve - nerve transfer - sensation
plexo braquial - nervos intercostais - nervo mediano - transferência de nervo - sensação


Publication History

Received: 03 February 2017

Accepted: 15 February 2017

Article published online:
05 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Brunelli G, Monini L. Neurotization of avulsed roots of brachial plexus by means of anterior nerves of cervical plexus. Clin Plast Surg. 1984;11(1):149-52.
  • 2 Ihara K, Doi K, Sakai K, Kawai S, Kuwata N. Sensory reconstruction for total brachial plexus palsy of root-avulsed type. J Jpn Soc Surg Hand. 1992;9:472-5.
  • 3 Kotani T, Toyoshima Y, Matsuda H Suzuki T, Ishizaki Y. The postoperative results of nerve transfer for the brachial plexus injuries with root avulsion. Seikeigeka. 1971;22:963-66.
  • 4 Nagano A, Tsuyama N, Ochiai N, Hara T, Takahashi M. Direct nerve crossing with the intercostal nerve to treat avulsion injuries of the brachial plexus. J Hand Surg Am. 1989;14(6):980-5. https://doi.org/10.1016/S0363-5023(89)80047-4
  • 5 Nakatuchi Y, Saitou S, Hosaka M, Tada H, Kamidaira M. Reconstruction of sensory function for brachial palsy. J Jpn Soc Surg Hand. 1988;5:156-60.
  • 6 Williams PL, Bannister LH, Berry MM. Thoracic ventral rami. In: Williams PL, Bannister LH, Berry MM, editors. Gray’s anatomy. 38th ed. London: Churchill Livingstone; 1999. p. 1275-76.
  • 7 Morrow M. Segmental mastectomy and axillary dissection. In: Baker RJ, Fischer JE, editors. Mastery of surgery. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2001. p. 588-96.
  • 8 Cunnick GH, Upponi S, Wishart GC. Anatomical variants of the intercostobrachial nerve encountered during axillary dissection. Breast. 2001;10(2):160-2. https://doi.org/10.1054/brst.2000.0226
  • 9 Ghaderi B, Hoenig JM, Dado D, Angelats J, Vandevender D. Incidence of intercostobrachial nerve injury after transaxillary breast augmentation. Aesthet Surg J. 2002;22(1):26-32. https://doi.org/10.1067/maj.2002.121957
  • 10 Kubala O, Prokop J, Jelínek P, Ostruszka P, Tošenovský J, Ihnát P et al. [Anatomic-surgical study of intercostobrachial nerve (ICBN) course in axilla during I and II level of axilla clearance in breast cancer and malignant melanoma]. Rozhl Chir. 2013;92(6):320-9. Czech.
  • 11 Loukas M, Hullett J, Louis RG Jr, Holdman S, Holdman D. The gross anatomy of the extrathoracic course of the intercostobrachial nerve. Clin Anat. 2006;19(2):106-11. https://doi.org/10.1002/ca.20226
  • 12 O’Rourke MGE, Tang TS, Allison SI, Wood W. The anatomy of the extrathoracic intercostobrachial nerve. Aust N Z J Surg. 1999;69(12):860-4. https://doi.org/10.1046/j.1440-1622.1999.01718.x
  • 13 Taira N, Shimozuma K, Ohsumi S, Kuroi K, Shiroiwa T, Watanabe T et al. Impact of preservation of the intercostobrachial nerve during axillary dissection on sensory change and health-related quality of life 2 years after breast cancer surgery. Breast Cancer. 2014;21(2):183-90. https://doi.org/10.1007/s12282-012-0374-x
  • 14 Zhu JJ, Liu KF, Zhang PL, Yang JZ, Wang J, Qin Y et al. Anatomical information for intercostobrachial nerve preservation in axillary lymph node dissection for breast cancer. Genet Mol Res. 2014;13(4):9315-23. https://doi.org/10.4238/2014.January.24.13
  • 15 Hattori Y, Doi K, Sakamoto S, Yukata K. Sensory recovery of the hand with intercostal nerve transfer following complete avulsion of the brachial plexus. Plast Reconstr Surg 2009;123(1):276-83. https://doi.org/10.1097/PRS.0b013e31819348a7
  • 16 Levy BF, Cunha JC, Chadi G. Cellular analysis of S100Beta and fibroblast growth factor-2 in the dorsal root ganglia and sciatic nerve of rodents: focus on paracrine actions of activated satellite cells after axotomy. Int J Neurosci. 2007;117(10):1481-503. https://doi.org/10.1080/15569520701502716
  • 17 Bertelli JA. Distal sensory nerve transfers in lower-type injuries of the brachial plexus.J Hand Surg Am. 2012;37(6):1194-9. https://doi.org/10.1016/j.jhsa.2012.02.047
  • 18 Ruchelsman DE, Price AE, Valencia H, Ramos LE, Grossman JA. Sensory restoration by lateral antebrachial cutaneous to ulnar nerve transfer in children with global brachial plexus injuries. Hand (NY). 2010;5(4):370-3. https://doi.org/10.1007/s11552-010-9284-6
  • 19 Ihara K, Doi K, Sakai K, Kuwata N, Kawai S. Restoration of sensibility in the hand after complete brachial plexus injury. J Hand Surg. 1996;21(3):381-6. https://doi.org/10.1016/S0363-5023(96)80348-0
  • 20 Kawai H, Kawabata H, Masada K, Ono K, Yamamoto K, Tsuyuguchi Y et al. Nerve repairs for traumatic brachial plexus palsy with root avulsion. Clin Orthop Relat Res. 1988;(237):75-86.
  • 21 Millesi H. Surgical management of brachial plexus injuries. J Hand Surg. 1977;2(5):367-78. https://doi.org/10.1016/S0363-5023(77)80046-4
  • 22 Narakas AO, Hentz VR. Neurotization in brachial plexus injuries: indication and results. Clin Orthop Relat REs. 1988;(237):43-56.
  • 23 Ogino T, Naito T. Intercostal nerve crossing to restore elbow flexion and sensibility of the hand for a root avulsion type of brachial plexus injury. Microsurgery. 1995;16(8):571-7. https://doi.org/10.1002/micr.1920160812
  • 24 Sedel L. The results of surgical repair of brachial plexus injuries. J Bone Joint Surg. 1982;64(1):54-66.
  • 25 Maycock LA, Dillon P, Dixon JM. Morbidity related to intercostobrachial nerve damage following axillary surgery for breast cancer. Breast. 1998;7(4):209-12. https://doi.org/10.1016/S0960-9776(98)90110-2
  • 26 Penfield W, Boldrey E. Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain. 1937;60(4):389-443. https://doi.org/10.1093/brain/60.4.389
  • 27 Andersen KG, Aasvang EK, Kroman N, Kehlet H. Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer. Acta Anaesthesiol Scand. 2014;58(10):1240-8. https://doi.org/10.1111/aas.12393
  • 28 Khan A, Chakravorty A, Gui GP. In vivo study of the surgical anatomy of the axilla. Br J Surg. 2012;99(6):871-7. https://doi.org/10.1002/bjs.8737
  • 29 Hwang K, Huan F, Hwang SW, Kim SH, Han SH. The course of the intercostobrachial nerve in the axillary region and as it is related to transaxillary breast augmentation. Ann Plast Surg. 2014;72(3):337-9. https://doi.org/10.1097/SAP.0b013e31825c07ba
  • 30 Clemente CD. Ventral primary divisions of the spinal nerves. In: Clemente CD, editor. Gray’s anatomy. 30th edn. Baltimore: Williams and Wilkins; 1995. p. 1223-5.