Robotic microsurgery for pediatric peripheral nerve surgery.

The technology of microsurgical robotic systems has shown potential benefit during the last decade for a variety of microsurgical procedures, such as vascular anastomoses, lymphatic anastomoses or nerve coaptation. At the same time, peripheral nerve surgery has produced ever more sophisticated nerve transfers in which the smallest nerve structures are connected to each other. Following obstetric brachial plexus injuries, nerve reconstruction surgery is often required in the first few years of life in order to improve the function of the affected arm, including nerve transfers to denervated muscles, which enable reinnervation of target muscles. In pediatric patients, these donor-nerve structures are even smaller than in adults, which further increases the demands to the microsurgeon. In this publication, we show the possible applications, capabilities and limitations of a dedicated microsurgical robotic system for nerve transfers in pediatric patients.

Anterior Transfer of the Long Head of Triceps Nerve to the Terminal Part of the Anterior Division of the Axillary Nerve Through Two Incisions: A Cadaveric Feasibility Study.

PURPOSE: Restoring shoulder function after axillary nerve injury is always a challenge. Transferring a branch of the radial nerve destined to the triceps onto the anterior division of the axillary nerve has become the preferred technique. However, this is not always possible, especially when the axillary nerve is severely injured around the posterior part of the humeral neck. The purpose of this cadaver study was to assess the feasibility of transferring the nerve of the long head of the triceps through an anterior and lateral humeral neck tunnel, directly onto the branch of the anterior division of the distal axillary nerve where it enters the deltoid fibers, by two surgical approaches. MATERIALS AND METHODS: This anatomical study was performed using 6 fresh cadavers (12 shoulders). A medial brachial approach was used to locate the radial nerve and its first branch, innervating the long head of the triceps. Then a second, transdeltoid approach was made to locate the end of the anterior branch near where it enters the deltoid fibers. The long head of the triceps nerve was transected as close as possible to the muscle, to provide the longest length possible. Then an anterior and lateral subdeltoid tunnel was made to retrieve this branch through the transdeltoid approach. RESULTS: The long head of the triceps nerve could always be sutured to the anterior branch of the axillary nerve. Given the 7-12 mm surplus length (mean, 8.8 mm), tensionless suturing was possible in an anatomical region amenable to easier microsurgery. DISCUSSION: Transfer of the long head of the triceps to the anterior branch of the axillary nerve through an axillary or posterior approach remains the preferred method for reinnervating the deltoid. However, in some patients, the axillary nerve is injured at or beyond the typical microsurgical suturing zone, which means that transfer cannot be accomplished under optimal conditions. For this reason, we suggest making the transfer more distally, using a dual approach that allows direct suturing of the long head of the triceps nerve onto the anterior terminal branch, which shortens the distance between the sutured nerve and the deltoid, and should improve outcome.

Exploring Outcomes and Mediating Factors Following Supercharged End-to-Side Anterior Interosseous Nerve to Ulnar Nerve Transfer: A Scoping Review With Expert Insight.

Purpose: This scoping review with expert insight aims to map outcome measures following supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer procedures, integrating clinical, patient-reported, and electrodiagnostic measures. It also explores surgical rationale and recovery trajectories, aiming to standardize methodologies and enhance patient care in nerve transfer surgeries. Methods: Our search encompassed multiple online databases, including MEDLINE, Embase, PubMed, and Google Scholar, ensuring rigor and comprehensiveness in identifying relevant literature. Results: Through scrutiny of 17 studies involving 300 patients from 300 articles, along with expert consultations on supercharged end-to-side nerve transfer for ulnar nerve entrapment, promising outcomes emerge, particularly in cubital tunnel syndrome. Primary measures such as Medical Research Council scale assessments and Disabilities of the Arm, Shoulder, and Hand scores demonstrate notable postsurgery improvements, with minor complications noted. Factors influencing recovery include preoperative dysfunction duration and surgical technique. Surgery indications prioritize high ulnar nerve injuries and severe cubital tunnel syndrome. Conclusions: The review highlights the importance of standardized outcome measures, early intervention, and comprehensive rehabilitation for optimizing supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer outcomes. Type of study/level of evidence: Therapeutic IIIa.

Case Report: Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for ulnar nerve neuropathy after cross pinning of pediatric supracondylar humerus fracture.

Ulnar nerve neuropathy following pediatric supracondylar humerus fracture fixation with cross pinning poses challenges in management. Despite various treatment strategies, including conservative approaches and early intervention, achieving complete neural recovery remains elusive in some cases. This paper presents a novel approach utilizing supercharged end-to-side anterior interosseous nerve transfer for a 13-year-old patient who experienced persistent ulnar neuropathy after K-wire removal. The patient underwent neurolysis of the ulnar nerve followed by nerve transfer, resulting in significant improvement in function and strength. This case highlights the potential efficacy of combining neurolysis and supercharge techniques in pediatric ulnar neuropathy cases refractory to conservative treatment, offering a promising avenue for enhancing patient outcomes.

Feasibility of a less invasive supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer.

The object of this study was to perform an anatomical dissection of Thiel-embalmed specimens in a step-by-step procedure, to establish a 'safe zone' in which to perform a less invasive supercharged end-to-side (SETS) anterior interosseous nerve to ulnar motor nerve transfer without tension and to demonstrate its feasibility. The sample size was calculated with a 5 mm error to reach a 95% confidence interval. Dissection was performed in 15 specimens and the 'safe zone' was established between 40 and 90 mm proximal to the pisiform. Several surgical tips are recommended to help complete the procedure. A reproducible 'safe zone' was found for performing a SETS anterior interosseous to ulnar motor nerve transfer with 95% certainty, reducing soft tissue damage and enhancing the original surgical technique.

Using Electrical Muscle Stimulation to Enhance Electrophysiological Performance of Agonist-Antagonist Myoneural Interface.

The agonist-antagonist myoneural interface (AMI), a surgical method to reinnervate physiologically-relevant proprioceptive feedback for control of limb prostheses, has demonstrated the ability to provide natural afferent sensations for limb amputees when actuating their prostheses. Following AMI surgery, one potential challenge is atrophy of the disused muscles, which would weaken the reinnervation efficacy of AMI. It is well known that electrical muscle stimulus (EMS) can reduce muscle atrophy. In this study, we conducted an animal investigation to explore whether the EMS can significantly improve the electrophysiological performance of AMI. AMI surgery was performed in 14 rats, in which the distal tendons of bilateral solei donors were connected and positioned on the surface of the left biceps femoris. Subsequently, the left tibial nerve and the common peroneus nerve were sutured onto the ends of the connected donor solei. Two stimulation electrodes were affixed onto the ends of the donor solei for EMS delivery. The AMI rats were randomly divided into two groups. One group received the EMS treatment (designated as EMS_on) regularly for eight weeks and another received no EMS (designated as EMS_off). Two physiological parameters, nerve conduction velocity (NCV) and motor unit number, were derived from the electrically evoked compound action potential (CAP) signals to assess the electrophysiological performance of AMI. Our experimental results demonstrated that the reinnervated muscles of the EMS_on group generated higher CAP signals in comparison to the EMS_off group. Both NCV and motor unit number were significantly elevated in the EMS_on group. Moreover, the EMS_on group displayed statistically higher CAP signals on the indirectly activated proprioceptive afferents than the EMS_off group. These findings suggested that EMS treatment would be promising in enhancing the electrophysiological performance and facilitating the reinnervation process of AMI.

Insights into the Medial Pectoral Nerve Transfer for Shoulder Abduction in Brachial Plexus Injuries: A Retrospective Case Series Analysis.

BACKGROUND: Treatment priority in C5, C6, and C7 brachial plexus root avulsion is the recovery of shoulder function through reinnervation of shoulder muscles. The medial pectoral nerve is a potential donor for axillary nerve transfer, but outcomes are sparsely reported. This study reports the results of medial pectoral nerve transfer to the axillary nerve. METHODS: We conducted a retrospective analysis of 12 patients with traumatic brachial plexus injury (C5, C6, and C7 root avulsion) who underwent medial pectoral nerve transfer to the axillary nerve. Sociodemographic and clinical characteristics, including electromyography findings, were documented. We assessed postoperative shoulder abduction strength and range of motion. Statistical analyses compared presurgery and postsurgery outcomes and contrasted our results with those from a study using spinal accessory nerve transfer to the suprascapular nerve. RESULTS: Postsurgery, the mean shoulder abduction range of motion was 65.45°, with a median strength of M2. Significant improvement was noted compared to preoperative values. However, outcomes did not significantly surpass those from spinal accessory nerve transfer. Electromyography showed a low incidence of motor unit action potentials in the deltoid. CONCLUSIONS: Medial pectoral nerve transfer to the axillary nerve did not yield superior results in shoulder abduction and deltoid reinnervation in our group of patients. At present, different nerve donors may also need to be considered for deltoid muscle reinnervation in patients with C5, C6, and C7 root avulsion to achieve better shoulder abduction recovery.

Results of spinal accessory nerve to suprascapular nerve transfers in children with brachial plexus birth injury.

Shoulder external rotation after brachial plexus birth injury can be restored by transfer of the spinal accessory nerve to the suprascapular nerve, or more distally to its infraspinatus branch. We studied the outcome of these nerve transfers in 52 patients with a minimum postoperative follow-up of 12 months (mean 7.3 years). The median postoperative improvement in shoulder external rotation was 120° (interquartile range [IQR] 45-135) after anterior and 110° (IQR 83-120) after dorsal spinal accessory nerve transfer to the suprascapular nerve main trunk, and 110° (IQR 80-125) after transfer to the infraspinatus branch. Patients operated after 20 months obtained external rotation ≥90° less frequently. The results of this study suggest that a decision about distal nerve transfer for shoulder external rotation is recommended at 1.5 years of age.Level of evidence: III.

Proximal and Distal Nerve Transfers in the Management of Brachial Plexus Injuries.

Nerve transfer surgery utilizes the redundant and synergistic innervation of intact muscle groups to rehabilitate motor function. This is achieved by transferring functional nerves or fascicles to damaged nerves near the target area, thereby reducing the reinnervation distance and time. The techniques encompass both proximal and distal nerve transfers, customized according to the specific injury. Successful nerve transfer hinges on accurate diagnosis, innovative surgical approaches, and the judicious choice of donor nerves to maximize functional restoration. This study explores nerve transfer strategies and their integration with other procedures, emphasizing their importance in enhancing outcomes in brachial plexus injury management.

Enhancing Lower Eyelid Suspension Outcomes Through Pre-surgical Facial Nerve Reanimation: A Comparative Study.

BACKGROUND: Lower eyelid suspension, a common therapeutic procedure for facial paralysis-induced eyelid retraction, faces challenges due to high recurrence in patients lacking facial muscle function and impedes wider adoption. This research aims to explore the potential effects of restoring orbicularis oculi muscle tension through facial nerve reanimation prior to lower eyelid suspension and to define the indications for lower eyelid suspension. METHODS: The study encompassed 32 individuals with complete facial paralysis, segmented into group A (reanimation group) and group B (non-reanimation group), based on whether the orbicularis oculi muscle's tension was restored through facial nerve reconstruction prior to lower eyelid suspension. Subjective assessments of eyelid closure (the inter-eyelid gap upon gentle closure) and objective methods measures of scleral show (the distance from the pupil's center to the lower eyelid margin, MRD2) were used to provide a comprehensive analysis of long-term effectiveness. RESULTS: The group A exhibited significantly greater long-term improvement in lagophthalmos and lower eyelid ectropion. The alterations in MRD2 measured 2.66 ± 0.27 mm in the group A versus 2.08 ± 0.53 mm in the group B, denoting a statistically significant variance (p < 0.001). Moreover, while the ratio of MRD2 preoperative 6 months postoperative revealed no significant difference between groups, a significant difference emerged in 12 months postoperative (group A: 1.02 ± 0.21; group B: 1.18 ± 0.24; p < 0.05), with the values in group A closer to 1, indicative of enhanced symmetry. CONCLUSIONS: Restoring the tension in the orbicularis oculi muscle through facial nerve reconstruction prior to palmaris longus tendon sling could effectively sustain long-term outcomes of lower eyelid retraction correction and reduce the recurrence rate. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Supinator to posterior interosseous nerve transfer to restore hand opening in brachial plexus and spinal cord injury: a systematic review and individual patient-data meta-analysis.

OBJECTIVE: Cervical spinal cord injury (SCI) and lower trunk brachial plexus injury (BPI) commonly result in hand paralysis. Although restoring hand function is complex and challenging to achieve, regaining volitional hand control drastically enhances functionality for these patients. The authors aimed to systematically review the outcomes of hand-opening function after supinator to posterior interosseous nerve (PIN) transfer. METHODS: A systematic literature review was performed according to the PRISMA guidelines. RESULTS: A total of 16 studies with 88 patients and 119 supinator to PIN transfers were included (87 transfers for SCI and 32 for BPI). In most studies, the time interval from injury to surgery was 6-12 months. Finger extension and thumb extension (Medical Research Council grade ≥ 3/5) recovered in 86.5% (103/119) and 78.1% (93/119) of cases, respectively, over a median follow-up of 19 months. The rates of recovery were similar for the SCI and BPI populations (finger extension, 87.3% in SCI and 84.3% in BPI; thumb extension, 75.8% in SCI and 84.3% in BPI). Type of injury (OR 1.05, 95% CI 0.17-6.4, p = 0.95), time from injury to surgery (OR 1.01, 95% CI 0.8-1.29, p = 0.88), and age (OR 0.97, 95% CI 0.90-1.06, p = 0.60) were not associated with odds of a successful outcome. Duration of follow-up was significantly associated with successful finger extension (OR 1.15, 95% CI 1.01-1.30, p = 0.026). No donor-associated supinator weakness was reported postoperatively given that patients had an intact bicep muscle preoperatively contributing to supination. CONCLUSIONS: Supinator to PIN transfer is a safe and effective procedure that can achieve successful restoration of digital extension in the SCI and BPI population at similar rates. Duration of follow-up was associated with superior outcomes, which was expected.

The recovery and independence of elbow flexion and forearm supination after Oberlin II transfer in brachial plexus injuries: a long term follows up study.

PURPOSE: The Oberlin II double fascicular nerve transfer has been evaluated extensively for objective outcomes for elbow flexion in brachial plexus injuries (BPI). However, there is limited information available on the recovery pattern of supination and patient-reported activity in the long-term. Our study aimed to assess the functional results with a minimum of five years of follow-up. METHODS: We evaluated patients with a minimum of five years after the Oberlin II procedure for post-traumatic BPI. They were evaluated using MRC grading, range of active movements, QuickDASH score and activity to check elbow flexion and forearm supination independent of finger and wrist flexion. RESULTS: 18 out of 26 patients responded with a mean follow-up of 79.4 months (range: 61-98). 16 (88.9%) (p < 0.000) patients recovered to achieve active elbow flexion and forearm supination of either MRC grade 3 power or more. The average range of active elbow flexion was 113.9° (range: 0-140°) and active supination was 67.8° (0-90°). Patients who achieved grade 3 flexion or higher were found to regain supination after a delay. The recovery continues even after two years of surgery. The mean QuickDASH score was 21.8 (range: 2.3-63.6). There's a significant inverse correlation between QuickDASH with both flexion and supination (p < .001 and < 0.05). 15 patients (83.3%) could demonstrate a dissociation of elbow and forearm movements from digital and wrist movements. CONCLUSION: Our study demonstrated reliable functional results with independent elbow flexion, forearm supination and acceptable patient-reported outcomes for Oberlin II procedure in BPI.

An Examination of Utilization Rates Over Time of Nerve and Tendon Transfers in Canada to Improve Upper Limb Function in Cervical Spinal Cord Injury.

Introduction: Upper limb function loss in cervical spinal cord injury (SCI) contributes to substantial disability, and negatively impacts quality of life. Nerve transfer and tendon transfer surgery can provide improved upper limb function. This study assessed the utilization of nerve and tendon transfer surgery for individuals with tetraplegia in Canada. Methods: Data from the Canadian Institute for Health Information's Discharge Abstracts Database and the National Ambulatory Care Reporting System were used to identify the nerve and tendon transfer procedures performed in individuals with tetraplegia (2004-2020). Cases were identified using cervical SCI ICD-10-CA codes and Canadian Classification of Intervention codes for upper extremity nerve and tendon transfers. Data on sex, age at time of procedure, province, and hospital stay duration were recorded. Results: From 2004 to 2020, there were ≤80 nerve transfer procedures (81% male, mean age 38.3 years) and 61 tendon transfer procedures (78% male, mean age 45.0 years) performed (highest in Ontario and British Columbia). Using an estimate of 50% eligibility, an average of 1.3% of individuals underwent nerve transfer and 1.0% underwent tendon transfer. Nerve transfers increased over time (2004-2009, n = <5; 2010-2015, n = 27; 2016-2019, n = 49) and tendon transfers remained relatively constant. Both transfer types were performed as day-surgery or single night stay. Conclusions: Nerve and tendon transfer surgery to improve upper limb function in Canadians with tetraplegia remains low. This study highlights a substantial gap in care for this vulnerable population. Identification of barriers that prevent access to care is required to promote best practice for upper extremity care.

Introduction : La perte de fonction du membre supérieur en cas de lésion de la moelle épinière cervicale (SCI0 contribue à un handicap substantiel avec des répercussions négatives sur la qualité de vie. La chirurgie de transfert des nerfs et des tendons peut apporter une amélioration du fonctionnement du membre supérieur. Cette étude a évalué l'utilisation de la chirurgie de transfert de nerfs et de tendons pour les patients tétraplégiques au Canada. Méthodes : Des données issues de la base de données des résumés de congés de l'Institut canadien d'information sur la santé du système national d'information sur les soins ambulatoires ont été utilisées pour identifier les procédures de transfert de nerfs et de tendons pratiquées sur des patients tétraplégiques entre 2004 et 2020. Les cas ont été identifiés en utilisant les codes de SCI cervicales du CIM-10-CA et des codes canadiens de classification des interventions pour les transferts de nerfs et de tendons du membre supérieur. Les données sur le sexe et l'âge au moment de la procédure, la province et la durée de séjour à l'hôpital ont été consignées. Résultats : Entre 2004 et 2020, il y a eu ≤ 80 procédures de transferts de nerfs (hommes : 81 %, âge moyen : 38,3 ans) et 61 procédures de transfert de tendons (hommes : 78 %, âge moyen : 45,0 ans) pratiquées (principalement en Ontario et en Colombie-Britannique). En estimant une admissibilité de 50 %, une moyenne de 1,3 % des patients a subi un transfert de nerfs et 1,0 % des patients a subi un transfert tendineux. Les transferts de nerfs ont augmenté au fil des années (2004-2009, n = < 5; 2010-2015, n = 27; 2016-2019, n = 49) tandis que le nombre de transferts tendineux est resté relativement stable. Les deux types de transferts ont été pratiqués das le cadre de la chirurgie d'un jour ou avec une hospitalisation d'une seule nuit. Conclusions : La chirurgie de transfert de nerfs et de tendons pour l'amélioration des fonctions des membres supérieurs reste peu utilisée pour les Canadiens tétraplégiques. Cette étude souligne une lacune substantielle des soins pour cette population vulnérable. Il est nécessaire d'identifier les obstacles qui empêchent l'accès aux soins afin de promouvoir une meilleure pratique pour les soins du membre supérieur.

Contemporary Approaches to Peripheral Nerve Surgery.

"State of the Art" Learning Objectives: This manuscript serves to provide the reader with a general overview of the contemporary approaches to peripheral nerve reconstruction as the field has undergone considerable advancement over the last 3 decades. The learning objectives are as follows: To provide the reader with a brief history of peripheral nerve surgery and some of the landmark developments that allow for current peripheral nerve care practices.To outline the considerations and management options for the care of patients with brachial plexopathy, spinal cord injury, and lower extremity peripheral nerve injury.Highlight contemporary surgical techniques to address terminal neuroma and phantom limb pain.Review progressive and future procedures in peripheral nerve care, such as supercharge end-to-side nerve transfers.Discuss rehabilitation techniques for peripheral nerve care.

Le présent manuscrit vise à fournir au lecteur un aperçu général des approches contemporaines de la reconstruction des nerfs périphériques puisque le domaine a beaucoup progressé depuis trois décennies. Les objectifs d'apprentissage s"établissent comme suit : Fournir au lecteur un bref historique de la chirurgie des nerfs périphériques et quelques-unes des avancées historiques qui ont donné lieu aux pratiques de soins actuelles des nerfs périphériques.Décrire les considérations et les possibilités de prise en charge pour les soins des patients ayant une plexopathie brachiale, une lésion médullaire ou une lésion des nerfs périphériques des membres inférieurs.Souligner les techniques chirurgicales contemporaines pour traiter les neurones terminaux et les douleurs des membres fantômes.Examiner les interventions progressives et futures pour les soins des nerfs périphériques, comme l'amplification du transfert du nerf terminal au nerf latéral.Parler des techniques de réadaptation pour les soins des nerfs périphériques.

Isolated musculocutaneous nerve injury in a motorcyclist - a case report.

INTRODUCTION: Isolated musculocutaneous nerve injuries occur rarely due to their anatomical location. We present our patient with a musculocutaneous nerve injury in a motorcyclist. CASE: The patient was initially treated for a motorcycle accident. Further examination of the patient revealed impaired elbow flexion and numbness of the lateral forearm. Electromyography confirmed impaired function of the musculocutaneous nerve. After 3 months, the patient's condition did not show any improvement, neither electromyography confirmed recovery of the nerve activity, so surgical treatment was planned. In the surgical revision, neuroma-in-continuity was discovered and resected. The resulting nerve defect was 6 cm long. We provided nerve grafting using sural nerve from the right lower limb. After surgery, the patient began physical therapy and electrical stimulation. Two years later, the patient reached complete recovery of muscle strength. CONCLUSION: Due to the lack of improvement after a 3-month period, we proceeded with a surgical revision, which demonstrated a complete lesion of the nerve that could not heal spontaneously. Therefore, we opted for the nerve graft method and the patient regained full function of elbow flexors.

[Anatomical cartography of the radial nerve at the elbow level for intraradial nerve transfers for finger extension reconstruction in spastic upper limb - A cadaveric study]. / Cartographie anatomique du nerf radial dans la région du coude pour son application aux transferts nerveux intraradiaux dans la chirurgie de la spasticité.

INTRODUCTION: Upper limb spasticity is a surgical challenge, both in diminishing agonists spasticity and reconstructing antagonist function. Brachioradialis (BR) is often involved in elbow flexors spasticity. Finger extension is often impaired in spastic patients. This study aims to demonstrate the feasibility of BR motor branch to posterior interosseous nerve (PIN) during BR selective neurectomies, and to describe fascicles topography inside the radial nerve to facilitate PIN dissection. MATERIAL AND METHOD: Ten upper limbs from 10 fresh frozen anatomical specimens were dissected. Motor branches to the BR, wrist extensors, supinator, PIN and radial sensory branch were identified. BR to PIN transfer was realized and its feasibility was studies (donor length, tensionless suture). RESULTS: BR to PIN transfer was achievable in 9 out of 10 cases. The position of the sensory branch of the radial nerve was inferior or medial in all cases. The position of the PIN was lateral in 90% of the cases. CONCLUSION: BR to PIN nerve transfer is achievable in most cases (90%). The lateral topography of the PIN and the inferomedial topography of the sensory branch in most cases allows for an easier intraoperative finding of the PIN when stimulation is not possible. LEVEL: IV, feasibility study.

The trapezius plane block: Extended use in perioperative pain management in nerve transfer surgeries.

Nerve transfer surgery has emerged as a promising approach to restoring function in paralyzed muscles. The trapezius plane block (TPB) blocks the thoracic branches of the posterior primary rami, providing extended analgesia in nerve transfer surgeries. The case report describes the analgesia profiling of a young man who suffered a traumatic pan-brachial plexus injury and underwent a spinal accessory nerve to the suprascapular nerve transfer. TPB was utilized as a part of multimodal analgesia. TPB represents an advancement in regional anesthesia, providing extended analgesia and reducing opioid consumption. TPB can promote patient comfort and facilitate early mobilization.

Functional Outcomes of Single-Stage Facial Reanimation Surgery With Radical Parotidectomy.

OBJECTIVES: Facial nerve sacrifice during radical parotidectomy can impair quality of life. This study assessed the effectiveness of single-stage facial reanimation surgery performed concurrently with radical parotidectomy in restoring facial function. METHODS: A retrospective analysis was conducted on patients who underwent single-stage facial reanimation combined with radical parotidectomy. The techniques employed included selective reinnervation and orthodromic temporalis tendon transfer. Outcomes were evaluated using the modified House-Brackmann and Terzis grading systems, Emotrics facial assessment, and the Facial Disability Index (FDI). RESULTS: Among the 13 patients studied (median age, 54 years; 69% male), 10 underwent selective reinnervation. Of these, nine patients demonstrated improvement, achieving House-Brackmann grade III and Terzis grade 4 or 5. The other three patients underwent tendon transfer and achieved moderate functional outcomes. Emotrics analysis revealed balanced facial symmetry in the selective reinnervation group. Furthermore, FDI scores indicated satisfactory physical and social/well-being functions. CONCLUSION: Single-stage facial reanimation effectively restores facial function in patients undergoing radical parotidectomy. This approach offers meaningful benefits in the early recovery of facial function.

Extensor Carpi Radialis Brevis Tendon Transfer for Thumb and Finger Flexion Reconstruction after Failed Extensor Carpi Radialis Brevis Motor Branch Transfer in a Tetraplegic Patient.

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic).