Editorial
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World J Orthop. Jul 18, 2013; 4(3): 107-111
Published online Jul 18, 2013. doi: 10.5312/wjo.v4.i3.107
Use of intercostal nerves for different target neurotization in brachial plexus reconstruction
Marios G Lykissas, Ioannis P Kostas-Agnantis, Ananstasios V Korompilias, Marios D Vekris, Alexandros E Beris
Marios G Lykissas, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY 10021, United States
Ioannis P Kostas-Agnantis, Ananstasios V Korompilias, Marios D Vekris, Alexandros E Beris, Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina 45110, Greece
Author contributions: All authors contributed equally to this paper.
Correspondence to: Marios G Lykissas, MD, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, United States. mariolyk@yahoo.com
Telephone: +1-513-6527207 Fax: +1-513-6527207
Received: February 2, 2013
Revised: May 3, 2013
Accepted: June 8, 2013
Published online: July 18, 2013
Processing time: 166 Days and 10 Hours
Abstract

Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles (i.e., latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration.

Keywords: Intercostal nerve; Brachial plexus reconstruction; Reinnervation; Root avulsion

Core tip: Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles (i.e., latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration.