Repair of the musculocutaneous nerve using the vagus nerve as donor by helicoid end‐to‐side technique: an experimental study in rats

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It is estimated that 20 million Americans suffer from peripheral nerve injuries caused by trauma and diseases (Allieu and Cenac, 1988; Alnot et al., 1998; Bhandari et al., 2009; Birch et al., 1998; Gu et al., 1992). Of these injuries, brachial plexus injuries (BPI) are considered to be some of the most challenging to treat. These are most commonly attributed to motor vehicle accidents and injuries of birth (Alnot et al., 1998). The most severe form of BPI is a total root avulsion injury, where the five associated nerve roots are avulsed from the spinal cord through traction forces directed along the affected arm and head. Due to the lack of suitable donor nerves on the injured side, these injuries are particularly devastating. Current treatments for BPI include neurolysis, nerve grafts, nerve transfer, and free‐muscle and pedicle‐muscle transfer. Of these, nerve transfer remains one of the most favored treatments for total root avulsion injuries (Bertelli, 2007; Bertelli and Ghizoni, 2016; Bhandari et al., 2009).
Neurotization is a viable option in shoulder and elbow reanimation following C5 and C6 root avulsion or rupture. To date, some of the most frequently used nerve sources include the phrenic nerve, spinal accessory nerve, cross C7 nerve, and intercostal nerves (Allieu and Cenac, 1988; Songcharoen et al., 1996; Gu et al., 1989; Gu, et al., 1989b; Chuang et al., 1995; Krakauer and Wood, 1994). This diversity of nerve source options affords the ability to tailor donor selection to the unique needs of the patient. Despite this, each choice brings with it a host of differing limitations, including inconsistent results, demographic contraindications, and the associated risks of donor nerve sacrifice (Alnot et al., 1998; Terzis and Papakonstantinou, 2000). In light of these limitations, there continues to be great impetus for the discovery of new repair methods and nerve transfer sources.
The vagus nerve (VN) is the longest cranial nerve, containing both motor and sensory fibers, and has a wider distribution than any other nerve in the human body. Because VN is a voluntary nerve and contains many parasympathetic nerve fibers, despite its proximity to the brachial plexus, it has never been investigated as a potential source for nerve transfer in BPI. The VN possesses a unique set of qualities that prompted our lab to investigate. Namely, it is easy to identify and dissect, has a wider diameter than many of the currently utilized sources, and is almost always available in surviving victims. Taking this into consideration, we performed this study with the intention of investigating if the VN could serve as a viable source for nerve transfer in total root avulsion brachial plexus injury.
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