Neurotization of the Axillary Nerve: A Case Series and Review of the Literature

Abstract

Background data: Axillary nerve is one of the branches of the posterior cord of the brachial plexus that carries nerve fi bers from C5 and C6 roots and then travels to innervate the deltoid muscle and teres minor muscle; it maintains stability of the shoulder joint and provides sensation to the overlying skin. Many techniques are present to manage axillary nerve injuries according to the applied anatomy to provide more safety during exploration. It may be isolated or combined injury, and each type has its speci fi c protocol. Study design: This is a retrospective clinical case study. Patients and methods: Between January 2018 and December 2019, eight male patients with an average age of 32.2 years (range, 20 e 45 years) presented with complete loss of shoulder abduction. All of the patients underwent microsurgical axillary nerve neurotization using transfer of the part of the radial nerve of the medial head of the triceps and suturing it into the stump of the axillary nerve. The posterior approach in the prone position was used in all patients. The axillary nerve stumpwas proximalto the origin of the nerve to teres minormuscle.Thesurgical intervention was done forall eightpatients by the same team. Preoperative and follow-up clinical evaluation was done by assessing the motor power of all the patients, which was clinically evaluated using the Motor Research Council scale. The mean follow-up period was 12 months. Results: A total of eight male patients who presented after a history of traumatic insults were included in the study. The average lapse between the traumatic insult and the surgical intervention was 5 months (range, 4 e 6 months). Shoulder abduction was grade 0 in all patients on the Motor Research Council scale. Five patients had complex de fi cits all over the upper limb among brachial plexus injuries, whereas three had isolated axillary nerve de fi cits. Overall, 62% of the patients ( fi ve patients) showed marked functional motor improvement, whereas three patients did not show any improvement. Mean time of the surgery was about 80 min. The mean amount of blood loss was 160 ml. The average period of recovery was 6 months, whereas the mean period of follow-up was 32 months. Conclusion: Harvesting the stump of the axillary nerve proximal to the takeoff of the branch of the teres minor muscle while suturing it with the radial nerve stump through the procedure of nerve transfer is the cardinal step for achieving functional motor recovery by gaining shoulder abduction (2021ESJ251).