Intraoperative Decision Making by Electrophysiological Detection of the Origin of Thoracodorsal Nerve in the C7 Nerve Root Transfer Procedure

ABSTRACT

The objective of this article is to discuss the significance of predicting the injury degree of the thoracodorsal nerve by intraoperative electrophysiological examination in the C7 nerve root transfer for brachial plexus injury. Each trunk of the brachial plexus followed by each bundle of C7 was stimulated before the contralateral C7 was disconnected. The ratio of the origination of thoracodorsal nerve controlling the latissimus dorsi muscle was evaluated. The highest ratio of the origination of thoracodorsal nerve controlling the latissimus dorsi muscle was in the middle trunk of the brachial plexus. In the middle trunk, the highest ratio was the posterior division. In the posterior division, the internal fascicles were the predominant ones. The intraoperative electrophysiological examination can precisely locate the origin of the dominated nerve of latissimus dorsi muscle. It is recommended for safety to direct the operative procedure selection in the C7 transfer.

KEYWORDS

Intraoperative - electrophysiological - origin - thoracodorsal nerve - C7

REFERENCES

• 1 Lanaras T I, Schaller H E, Sinis N. Brachial plexus lesions: 10 years of experience in a center for microsurgery in Germany.  Microsurgery. 2009;  29 87-94
• 2 Terzis J K, Kokkalis Z T, Kostopoulos E. Contralateral C7 transfer in adult plexopathies.  Hand Clin. 2008;  24 389-400, vi
• 3 Zhang C G, Terenghi G, Mantovani C, Wiberg M. Neuronal survival, regeneration and musclemorphology after posterior C7 nerve transfer: an experimental study.  J Plast Reconstr Aesthet Surg. 2006;  59 717-725
• 4 Hierner R, Berger A K. Did the partial contralateral C7-transfer fulfill our expectations? Results after 5 year experience.  Acta Neurochir Suppl. 2007;  100 33-35
• 5 Mcguiness C N, Kay S P. The prespinal route in contralateral C7 nerve root transfer for brachial plexus avulsion injuries.  J Hand Surg [Br]. 2002;  27 159-160
• 6 Chen L, Xu L, Gu Y et al.. [Clinical significance of electrophysiological dominance analysis of triceps brachii muscle/extensor digitorum communis muscle innervation in ipsilateral C7 transfer].  Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008;  22 1036-1039
• 7 Gu Y D, Cai P Q, Xu F, Peng F, Chen L. Clinical application of ipsilateral C7 nerve root transfer for treatment of C5 and C6 avulsion of brachial plexus.  Microsurgery. 2003;  23 105-108
• 8 Gu Y D, Zhang G M, Chen D S, Yan J G, Cheng X M, Chen L. Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion.  J Hand Surg [Br]. 1992;  17 518-521
• 9 Minachenk V K, Blandinskio V F, Komarevtsev V D. [Latissimus dorsi muscle flap for autologous myoplasty in children with sequelae to obstetric paralysis of the Duchenne-Erb type].  Klin Khir. 1991;  6 18-21
• 10 Haninec P, Dubový P, Sámal F. Reconstruction of elbow flexion, wrist and finger extension by transposition of pedicled latissimus dorsi muscle and flexor carpi ulnaris muscle.  Acta Chir Plast. 2001;  43 80-85
• 11 Gu Y D. Diagnosis and Treatment of Brachial Plexus Injury and Related Diseases. 2nd ed. Shanghai: FuDan University Publishing; 2001
• 12 Lu W, Xu J G, Wang D P, Gu Y D. Microanatomical study on the functional origin and direction of the thoracodorsal nerve from the trunks of brachial plexus.  Clin Anat. 2008;  21 509-513
• 13 Tang X F. Clinical Electromyography. 1st ed. Beijing, China: People's Publishing; 1995: 84
• 14 Chen L, Gu Y D, Li D C et al.. An experimental study of the least nerve roots of the brachial plexus for maintaining the normal limb function.  Chinese J Hand Surgery. 1998;  14 234-238