Medial Triceps to Anterior Branch of Axillary Nerve Transfer: A Case of Specific Reinnervation 4 Mackinnon SE1 Yee A1 March 15, 2015Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.The axillary nerve has several distal branches that provide shoulder function through the innervation of the anterior, middle, and posterior deltoid and teres minor, as well as sensation to the lateral arm. Injury to the axillary nerve has been traditionally viewed as either a complete non-favorable injury where recovery does not occur or a favorable injury where recovery does occur. However, there are situations of mixed injuries where both these scenarios are true, and the axillary nerve has components that will and will not recovery. This mixed nerve injury can be confirmed with the use of electrodiagnostic studies. Management of these cases is to reinnervate the non-recovering components, while protecting the recovering components. The medial triceps branch is an available donor for reconstruction. In this case, the patient suffered an upper brachial plexus injury following a severe fall and lost shoulder function. Electromyography at three months post-injury reported motor unit potentials in the middle and posterior deltoid to recovery, however the anterior deltoid did not have motor unit potentials. Specific reinnervation of the anterior branch of the axillary nerve using the medial triceps branch nerve transfer was elected. This video details the specifics of this nerve transfer.Keywords: mixed nerve injuryaxillary nervenerve transfershoulder functionspecific reinnervationbrachial plexusmedial triceps branch of radial nerve You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:25 - Incision and Superficial Dissection00:02:15 - Dissection along the Posterior Border of the Deltoid00:03:09 - Identifying the Superior Lateral Cutaneous Branch and Axillary Nerve00:05:49 - Identifying the Teres Minor and Exposure of Quadrangular Space00:07:53 - Electrical Stimulation and Dissection of Anterior Branch of Axillary Nerve00:09:33 - Fascicular Neurolysis of Individual Anterior Branches of Axillary Nerve00:10:18 - Dissection of Individual Recipient Anterior Branch of Axillary Nerve00:11:57 - Exposure between the Long and Lateral Heads of the Triceps00:12:22 - Identifying the Teres Major and Exposure of Triangular Space00:13:25 - Identification of the Radial Nerve and Triceps Branches00:14:40 - Additional Dissection between the Heads of Triceps for Distal Exposure00:15:28 - Dissection of the Donor Medial Triceps Branch00:16:15 - Proximal Dissection and Division of Anterior Branch of Axillary Nerve00:16:55 - Distal Dissection and Division of Medial Triceps Branch00:18:01 - Medial Triceps to Anterior Branch of Axillary Nerve Transfer You must login to view the full article and extended video on this page. 1 Comment Howard Pecker 13th May 2018 Great dissection. I had a little chuckle when you were saying how great the length was and then put you finger under to show that it was about 2 finger-breaths. Log in to Reply | Leave a Comment Cancel replyYou must be logged in to post a comment.