We conducted an anatomic study to provide detailed information on the pectoral nerves and anatomic data on the transfer of the pectoral nerves to the axillary nerve. Moreover, we experimentally determined the feasibility of transferring the pectoral nerves to the suprascapular nerve in upper brachial plexus injury.
We dissected 26 brachial plexus from 15 fresh cadavers. The origin, location, course, and branching of the pectoral nerves were recorded. The length and the diameter of the pectoral nerves were measured. The diameter of the suprascapular and axillary nerves was recorded. In all dissections, we assessed the feasibility of directly transferring the pectoral nerves to the suprascapular and axillary nerves.
We found 3 constant branches of pectoral nerves arising from 3 distinct origins in 20 cases, and 3 constant branches arising from 2 distinct origins in 6 cases. The C7 sent nerve fibers to all 3 branches. The average length and diameter of the superior, middle, and inferior branches of the pectoral nerves were 65 mm, 110 mm, and 105 mm, and 2.0 mm, 2.3 mm, ad 2.4 mm, respectively. The average diameter of the suprascapular and axillary were 2.8 mm and 3.6 mm, respectively. The superior branch reached the suprascapular and axillary nerves in 17 and 8 cases. The middle and inferior branches reached the suprascapular and axillary nerve in all dissections.
With an adequate length, diameter, and nerve composition, the middle and inferior branches of the pectoral nerves are suitable donor nerves to the axillary nerve and a potential source of reinnervation of the suprascapular nerve in upper brachial plexus injury.
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- Surgical management of brachial plexus injuries.J Hand Surg. 1977; 2: 367-378
- Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers.Plast Reconstr Surg. 1995; 96: 122-128
- Combined nerve transfers for C5 and C6 brachial plexus avulsion injury.J Hand Surg. 2006; 31A: 183-189
- Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature.J Hand Surg. 2001; 26A: 303-314
- Nerve transfers for severe brachial plexus injuries: a review.Neurosurg Focus. 2004; 16: 1-10
- Suprascapular nerve reconstruction in 118 cases of adult posttraumatic brachial plexus.Plast Reconstr Surg. 2006; 117: 613-629
- Spinal accessory neurotization for restoration of elbow flexion in avulsion injuries of the brachial plexus.J Hand Surg. 1996; 21A: 387-390
- Physiology of movements.Paris: Baillière et Fils. 1867; : 2-17
- Paralysis of upper limb.in: Tubiana R. Hand surgery. 4. Masson, Paris1991: 113-125
- Concerning surgical treatment of traumatic injury of the upper division of the brachial plexus (Erb's-type).Ann Surg. 1948; 127: 317-326
- Nerve transfer in brachial plexus traction injuries.J Neurosurg. 1992; 76: 191-197
- A technique for maximizing biceps recovery in brachial plexus reconstruction.J Hand Surg. 1993; 18A: 726-733
- Clinical application of pectoral nerve transfers in the treatment of traumatic brachial plexus injuries.J Hand Surg. 2008; 33A: 1100-1107
- The brachial plexus, normal anatomy.in: Nerves and nerve injuries. 2nd ed. Churchill Livingstone, Edinburgh1978: 854-900
- The anatomy of the pectoral nerves and their significance in brachial plexus reconstruction.J Hand Surg. 2000; 25A: 942-947
- Clinically oriented anatomy.in: 5th ed. Lippincott Williams & Wilkins, Philadelphia2006: 773-781
- Anatomic variation of the spinal origins of lateral and medial pectoral nerves.Clin Anat. 2007; 20: 915-918
- Transfer of the medial pectoral nerve: myth or reality?.Neurosurgery. 2002; 50: 1277-1282
- Donor nerves in the reinnervation of brachial plexus.Neurol Res. 1986; 8: 117-122
- Surgical relationship of the medial pectoral nerve to the musculocutaneous nerve: a cadaveric study.Neurosurgery. 2001; 48: 203-206
- Posterior approach technique for accessory-suprascapular nerve transfer: a cadaveric study of the anatomical landmarks and number of myelinated axons.Clin Anat. 2007; 20: 140-143
- Innervation ratio is an important determinant of force in normal and reinnervated rat tibialis anterior muscles.J Neurophysiol. 1992; 67: 1385-1403
Accepted: September 8, 2009
Received: May 26, 2009
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© 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.