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Figure 3 | Journal of Brachial Plexus and Peripheral Nerve Injury

Figure 3

From: Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy

Figure 3

a and b – Schematic drawing showing the importance of placing grafts in an end(graft)-to-side(cord) and side(graft)-to-side(cord) fashion over an extensive area along the anterior cord to increase the chances of side neurotization. It also shows the technique of closed loop grafting as explained in Fig. 2. In (C5,6,7, 8T1 avulsions), one nerve graft is looped through the superior and middle trunks and lateral and posterior cords and another nerve graft is looped through the inferior trunk, medial cord and medial root of median nerve. In (C5,6 ruptures C7,8 T1 avulsions) the closed loop technique of end-to-side side-to-side grafting neurorrhaphy is used to graft the ruptured C5,6 roots to the superior trunk of the brachial plexus. Next, one nerve graft is looped through the middle trunk and posterior cord and another is looped through the inferior trunk, medial cord and medial root of median nerve.

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Journal of Brachial Plexus and Peripheral Nerve Injury

ISSN: 1749-7221