Results of 24 nerve repairs at more than one year post-injury.

There is no consensus in the literature as to the maximum delay for nerve repair following nerve injury. Our aim is to estimate the maximum delay at which a nerve can be successfully reconstructed. Eighteen patients (24 procedures) were operated at more than 12 months (12 to 36) post-injury. Mean age was 38 (17 to 74). There were 18 nerve transfers, four grafts and two secondary sutures for six target muscles. Evaluation of muscle power was scored and assessed against weights starting 12 months follow-up. Finally, two patients had contraction against 7 kg, two against 5 kg, six M4. Two were scored M3 and six were M2, thus 12 good results (67%). This study showed that excellent results could be obtained for nerve repair even after 24 months delay. Further study may be needed to determine the cut-off point of delay after which nerve recovery is unlikely.

Transfer of the first intercostal nerve to supra- and infraspinatus muscles: an anatomical study and report of the first case.

We have assessed the anatomical feasibility of a transfer of the first intercostal nerve to the supra- and infraspinatus muscles and report on the first clinical application. Ten fresh cadavers were dissected for this study. Histomorphometric analysis showed the fascicular surface area of the first intercostal nerve at its origin (0.38 mm(2)) to be comparable to the suprascapular nerve (0.81 mm(2)). The first intercostal nerve is usually a pure motor nerve. Preservation of the spinal accessory nerve, lack of donor site morbidity and direct suture without nerve graft are the other advantages of this transfer. Its principal indication is in lesions of the upper brachial plexus, used in association with neurotisation of two other intercostal nerves to the anterior branch of the axillary nerve. At 21 months follow-up there was useful motor reinnervation in the first clinical case.