Figure List For Chapter: Brachial Plexus Injuries

Brachial Plexus Injuries - Figure 01
Figure 1. Standard infraclavicular incision for brachial plexus exploration (dotted line) with extension distally along brachial sulcus on medial aspect of upper arm (solid line) for exposure of major peripheral nerves.

Brachial Plexus Injuries - Figure 02a
Figure 2a Musculocutaneous (upper) nerve with bicep and brachialis muscle branches identified (vessel loops) and LABC is middle branch. Median (middle) and ulnar nerves (lower) after internal neurolysis performed to identify redundant FCU fascicle(s) (vessel loops). Remainder of ulnar nerve activates ulnar motor function in the hand upon stimulation.

Brachial Plexus Injuries - Figure 02b
Redundant FCU fascicle transferred directly to biceps branch, and reconstruction augmented with transfer of medial pectoral branches to brachialis muscle branch with nerve graft (see Figure 5,6). Vessel loop around remainder of musculocutaneous nerve with terminal branch (LABC) traveling to forearm.

Brachial Plexus Injuries - Figure 03a
Medial pectoral nerve branches identified on deep surface of pectoralis major muscle.

Brachial Plexus Injuries - Figure 03b
Medial pectoral branches transferred directly to proximal musculocutaneous nerve.

Brachial Plexus Injuries - Figure 04
Dissection of 5th and 6th intercostal nerves and a segmental nerve (R) to the rectus abdominis. Musculocutaneous nerve (MC) divided and distal stump mobilized to demonstrate reach to intercostal nerves. (Patient oriented with head down)

Brachial Plexus Injuries - Figure 05a
Depiction of normal brachial plexus anatomy.

Brachial Plexus Injuries - Figure 05b
Modified Oberlin procedure with transfer of redundant FCU fascicle of ulnar nerve to biceps branch of musculocutaneous nerve, augmented with transfer of medial pectoral nerve to brachialis branch with nerve graft.

Brachial Plexus Injuries - Figure 06a
Exposure for modified Oberlin procedure with musculocutaneous nerve demonstrating biceps, brachialis and LABC branches, and ulnar nerve with redundant FCU fascicle after internal neurolysis.

Brachial Plexus Injuries - Figure 06b
Redundant ulnar nerve FCU fascicle transferred directly to biceps branch, and medial pectoral nerve branches transferred to brachialis branch with nerve graft.

Brachial Plexus Injuries - Figure 06c
Closer view of transfers to biceps and brachialis branches of musculocutaneous nerve.

Brachial Plexus Injuries - Figure 07a
Exposure of sensory nerves in the hand. Vessels loops around the common digital nerves to the 4th webspace and the thumb and index finger.

Brachial Plexus Injuries - Figure 07b
Nerve to the 4th webspace transferred directly to the common nerve to the thumb and index finger.

Brachial Plexus Injuries - Figure 08
Modification of modified Oberlin transfer. Redundant FCU fascicle of ulnar nerve is transferred directly to biceps branch of musculocutaneous nerve in standard fashion. Medial pectoral nerve branches are transferred with short nerve graft(s) to proximal musculocutaneous nerve to allow regeneration of motor fibers to the brachialis muscle and through the LABC to the forearm. The LABC in the proximal forearm will then be used in a later procedure to motor a free muscle transferred to the forearm for finger movement.

Brachial Plexus Injuries - Figure 09a and 09b
Long-term postoperative result after modified Oberlin reconstruction for elbow flexion. Patient demonstrating 4/5 elbow flexion strength.

Brachial Plexus Injuries - Figure 10
Another long-term result after modified Oberlin procedure with 4+/5 elbow flexion strength being demonstrated.