Courtesy : Authors: Susan E. Mackinnon, Andrew Yee Affiliation: Washington University School of Medicine Division of Plastic Reconstructive Surgery, Department of Surgery, Saint Louis, MO Peripheral Nerve Surgery: http://nervesurgery.wustl.edu
Injury to the axillary nerve results in the loss of shoulder function, specifically deltoid and teres minor deficits. This injury can either be isolated or more commonly associated with an upper brachial plexus injury that includes the C5,6 roots. The medial triceps is an available donor for nerve transfer into the axillary nerve and is one part of the double shoulder nerve transfers for shoulder reconstruction following nerve injury. Nerve transfers for the axillary nerve includes reinnervating the deltoid, teres minor, and superior lateral cutaneous nerve territory. In this case, the patient presented six months following a right pan brachial plexus injury with complete C5,6 injury and scapular fracture after a severe ATV accident. While some recovery occurred in the middle/lower plexus, electrodiagnostic studies confirmed no recovery to elbow flexion, deltoid and supra/infraspinatus muscles. The triceps were recovering and thus a medial triceps to axillary nerve transfer was elected with the spinal accessory to suprascapular nerve transfer for shoulder reconstruction. A superior lateral cutaneous end-to-side to radial sensory nerve transfer was also performed for sensation. This video details a reconstruction strategy for the axillary nerve.
Tables of Contents (Extended) 00:35 Incision and Superficial Dissection 04:45 Dissection along the Posterior Border of the Deltoid 07:40 Identifying the Superior Lateral Cutaneous Branch of Axillary Nerve 09:36 Identifying the Terminal Branches of the Axillary Nerve 11:56 Identification of the Axillary Nerve and Teres Minor Branch 15:45 Proximal Division of the Recipient Axillary Nerve 17:20 Dissection between the Long and Lateral Head of the Triceps 20:33 Identifying the Tendinous Leading-edge of Teres Major 21:33 Dissection of the Triangular Space 25:19 Identification of the Medial Triceps Branch and Radial Nerve 27:02 Neurolysis of the Sensory Component of the Radial Nerve 28:46 Distal Dissection and Division of the Medial Triceps Branch 32:53 Neurolysis of Superior Lateral Cutaneous Branch from Axillary Nerve 34:48 Medial Triceps to Axillary Nerve Transfer 35:24 Radial Sensory to Superior Lateral Cutaneous End-to-side Nerve Transfer 36:41 Release of the Tendinous Leading-edge of Teres Major
Narration: Susan E. Mackinnon Videography: Andrew Yee