Anatomical aspects of the use of the thoracodorsal nerve as a donor in musculocutaneous nerve ­injury

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Abstract


Aim. To assess the anatomical possibility of the use of the thoracodorsal nerve as a donor for nerve transfer to the musculocutaneous nerve.

Methods. Anatomical dissection of the brachial plexus with layer-by-layer dissection of secondary bundles, short and long branches was performed in 121 male and female corpses. The localization of the origin of thoracodorsal and musculocutaneous nerves relative to the clavicle, the takeoff angle (degrees) from the secondary bundle, the length (in centimeters) of the nerves from the site of origin to the latissimus dorsi muscle entry point and the perforation of the coracobrachialis muscle, respectively, were investigated. The length of the thoracodorsal nerve with and without extramuscular branches was studied separately.

Results. It was revealed that, in 58.7% of cases, the thoracodorsal nerve has the optimal length required for transposition to the musculocutaneous nerve. The excess length of the thoracodorsal nerve was between 0.1 and 9.1 cm. In 41.3% of cases, the length of the thoracodorsal nerve is not enough for transposition. Of these, in 17.4% of cases, the shortage of the length of the thoracodorsal nerve was –2 cm or less, which categorically does not allow its transfer to the musculocutaneous nerve. Only in 5% of cases, the length of the nerve was not enough for transposition in the use of the thoracodorsal nerve with extramuscular branches.

Conclusion. Due to tension in many cases, the thoracodorsal nerve transfer to the musculocutaneous nerve can be performed with difficulty, and in some cases it is impossible, solving the problem in this category of people dictates the deve­lopment of new surgical techniques with the thoracodorsal nerve or the use of another nerve as a donor.


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About the authors

N S Gorbunov

Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky; Research Institute of Medical issues of the North

Email: gorbunov_ns@mail.ru
ORCID iD: 0000-0003-4809-4491
ResearcherId: W-4527-2017

Russian Federation, Krasnoyarsk, Russia; Krasnoyarsk, Russia

K V Kober

Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky

Author for correspondence.
Email: k-kober@mail.ru
ORCID iD: 0000-0001-5209-182X
ResearcherId: D-9666-2019

Russian Federation, Krasnoyarsk, Russia

E V Kasparov

Research Institute of Medical issues of the North

Email: clinic@impn.ru
ORCID iD: 0000-0002-5988-1688
ResearcherId: C-3621-2018

Russian Federation, Krasnoyarsk, Russia

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Supplementary files

Supplementary Files Action
1.
Рис. 1. Формирование грудоспинного (ГСН) и мышечно-кожного нервов (МКН): А — ключица; В — место отхождения МКН от латерального вторичного пучка плечевого сплетения; С — место вхождения МКН в клювовидно-плечевую мышцу; D — место отхождения ГСН от заднего вторичного пучка плечевого сплетения; 1 — МКН; 2 — ГСН; 3 — срединный нерв; 4 — лучевой нерв; 5 — локтевой нерв; 6 — подмышечный нерв

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2.
Рис. 2. Значение уровня отхождения грудоспинного (ГСН) и мышечно-кожного (МКН) нервов при транспозиции: А — ключица; В — отхождение МКН от латерального вторичного пучка; С — вхождение МКН в клювовидно-плечевую мышцу; D — отхождение ГСН от заднего вторичного пучка; I — при низком отхождении МКН относительно ГСН, необходимо больше длины ГСН для транспозиции; II — при высоком отхождении МКН относительно ГСН, необходимо меньше длины ГСН для транспозиции

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3.
Рис. 3. Расчёт дополнительной длины грудоспинного нерва (ГСН) при пересадке в позицию мышечно-кожного нерва (МКН): B — место отхождения МКН от латерального вторичного пучка плечевого сплетения; E — верхняя точка латерального вторичного пучка плечевого сплетения, противоположная месту отхождения ГСН; D — место отхождения ГСН от заднего вторичного пучка плечевого сплетения; 1 — МКН; 2 — ГСН

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© 2020 Gorbunov N.S., Kober K.V., Kasparov E.V.

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