Brachialis to Anterior Interosseous Nerve Transfer with Extended Forearm Incision 0 Mackinnon SE1 Yee A1 November 18, 2014Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Loss of flexor pollicis longus and radial profundus function results in a deficit of pinch and reduced grip strength in the hand. This palsy can be isolated or commonly included in a lower brachial plexus injury. The brachialis nerve is an available, synergistic, and powerful donor for transfer in these scenarios, especially in C7,8,T1 injuries and when other common donors are unavailable due to injury like the extensor carpi radialis brevis. In this case, the patient presented three months following a partial C7 and C8,T1 brachial plexus injury from a fall with no recovery on electrodiagnostic studies. The brachialis to anterior interosseous nerve transfer was elected with the supinator to flexor digitorum superficialis nerve transfer and lateral antebrachial cutaneous to ulnar sensory nerve transfer. This video details the specifics for the brachialis transfer with an extended incision into the forearm to confirm the proximal topography of the anterior interosseous fascicle in the median nerve. Additionally, this patient has an anomalous sensory nerve anastomosis from a brachialis nerve branch to the sensory component of the median nerve.Keywords: hand functionmedian nerveanterior interosseous nerveinterfascicular dissectionnerve transferbrachialis nervenerve injurybrachial plexus You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:57 - Proximal Arm Exposure00:01:51 - Exposure and Identification of Median Nerve in the Arm00:03:18 - Exposure and Identification of Musculocutaneous Nerve and Brachialis Branch00:04:41 - Neurolysis of Median Nerve to Identify the Pronator Teres and AIN Fascicles00:07:38 - Distal Forearm Exposure00:08:34 - Step-lengthening the Pronator Teres for Proximal Median Nerve Exposure00:10:36 - Exposure of Median Nerve in the Forearm00:11:05 - Identifying the Distal Pronator Teres Branch00:12:20 - Identifying the Proximal Pronator Teres Branch and Proximal Neurolysis00:12:52 - Exposure of Anterior Interosseous Nerve Branch00:14:16 - Extension of Proximal Arm Exposure00:14:58 - Fascicular Course of the Anterior Interosseous Nerve from Distal to Proximal00:16:42 - Dissection and Distal Division of Donor Brachialis Nerve Branch00:17:27 - Anomalous Sensory Anastomosis from Brachialis Nerve Branch to Median Nerve00:18:25 - Neurolysis and Proximal Division of Recipient Anterior Interosseous Fascicle00:19:42 - Brachialis to Anterior Interosseous Nerve Transfer You must login to view the full article and extended video on this page. Leave a Comment Cancel replyYou must be logged in to post a comment.