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.
A curved incision along the posterior border of the deltoid with a linear incision between the lateral and long head of the triceps brachii.
- Bertelli JA, Ghizoni MF. Nerve transfer from triceps medial head and anconeus to deltoid for axillary nerve palsy. J Hand Surg Am. 2014 May;39(5):940-7. PMID: 24582845.
- Tung TH, Mackinnon SE. Nerve transfers: indications, techniques, and outcomes. J Hand Surg Am. 2010 Feb;35(2):332-41. Review. PMID: 20141906.
- Ray WZ, Mackinnon SE. Management of nerve gaps: autografts, allografts, nerve transfers, and end-to-side neurorrhaphy. Exp Neurol. 2010 May;223(1):77-85. Review. PMID: 19348799.
- Colbert SH, Mackinnon SE. Nerve transfers for brachial plexus reconstruction. Hand Clin. 2008 Nov;24(4):341-61, v. Review. PMID: 18928885.
- Mackinnon SE, Colbert SH. Nerve transfers in the hand and upper extremity surgery. Tech Hand Up Extrem Surg. 2008 Mar;12(1):20-33. Review. PMID: 18388751.
- Pannucci C, Myckatyn TM, Mackinnon SE, Hayashi A. End-to-side nerve repair: review of the literature. Restor Neurol Neurosci. 2007;25(1):45-63. Review. PMID: 17473395.
- Walker JC, Brenner MJ, Mackinnon SE, Winograd JM, Hunter DA. Effect of perineurial window size on nerve regeneration, blood-nerve barrier integrity, and functional recovery. J Neurotrauma. 2004 Feb;21(2):217-27. PMID: 15000762.
- Goheen-Robillard B, Myckatyn TM, Mackinnon SE, Hunter DA. End-to-side neurorrhaphy and lateral axonal sprouting in a long graft rat model. Laryngoscope. 2002 May;112(5):899-905. PMID: 12150625.
- Tarasidis G, Watanabe O, Mackinnon SE, Strasberg SR, Haughey BH, Hunter DA. End-to-side neurorraphy: a long-term study of neural regeneration in a rat model. Otolaryngol Head Neck Surg. 1998 Oct;119(4):337-41. PMID: 9781986.
- Tarasidis G, Watanabe O, Mackinnon SE, Strasberg SR, Haughey BH, Hunter DA. End-to-side neurorrhaphy resulting in limited sensory axonal regeneration in a rat model. Ann Otol Rhinol Laryngol. 1997 Jun;106(6):506-12. PMID: 9199612.