Medial Triceps to Axillary Nerve Transfer - Extended (Feat. Dr. Mackinnon)

Medial Triceps to Axillary Nerve Transfer - Extended
Authors: Mackinnon SE1, Yee A1
Published: January 13, 2015

AUTHOR INFORMATION
1 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

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.