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Wen-Dong Xu, Yu-Dong Gu, Jing-Bo Liu, Cong Yu, Cheng-Gang Zhang and Jian-Guang Xu

patients may more truly represent those with complete unilateral phrenic nerve injury because the accessory phrenic nerve was not spared when the phrenic nerve was harvested from the thoracic cavity. Clinical Material and Methods Between August 1999 and March 2001, a total of 15 patients with total brachial plexus avulsion injuries underwent full-length phrenic nerve transfer to MCN by means of VATS (13 men and two women; age range 17–38 years; average age of 27.4 years). Seven VATS were performed on the left side and eight on the right side. The average

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Wen-Dong Xu, Jiu-Zhou Lu, Yan-Qun Qiu, Su Jiang, Lei Xu, Jian-Guang Xu and Yu-Dong Gu

T he treatment of complete BPAI is a demanding and difficult surgery in the upper extremity. Currently, nerve transfer is the main method of treating BPAI. 22 However, the traditional means of nerve transfer lead to poor functional recovery of hand prehension, mainly attributable to the long distance between the nerve anastomosis site and the reinnervated antebrachial muscle. TABLE 1 Complete brachial plexus avulsion injury in 3 patients treated with full-length PN transfer to the medial root of the median nerve

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Zhen Dong, Cheng-Gang Zhang and Yu-Dong Gu

P hrenic nerve transfer to the anterior division of the upper trunk of the brachial plexus is one of the most frequently used surgical procedures in our clinic to restore elbow flexion in treating brachial plexus avulsion injury. We followed 40 consecutive patients who underwent this surgery between 2002 and 2005. The results are reported and evaluated. Methods Patient Population Forty cases were included in this study. There were 35 male and 5 female patients, with injuries to 21 left and 19 right brachial plexuses. The mean age at operation was

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Zhen Dong, Yu-Dong Gu, Cheng-Gang Zhang and Lei Zhang

Clinical Data Between October 2007 and July 2009, 4 patients with C7–T1 brachial plexus avulsion underwent a supinator motor branch to posterior interosseous nerve transfer in our clinic. The general data are listed in detail in Table 1 . The diagnosis was made based on physical examination, electrophysiological testing, MR imaging, and the Horner sign (positive in all 4 cases). Preoperatively, the muscle strengths of the supinator and brachialis were graded M4, and EMG revealed normal CMAP of the muscles, confirming good functional status of the upper plexus

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Chuan-Tao Zuo, Xu-Yun Hua, Yi-Hui Guan, Wen-Dong Xu, Jian-Guang Xu and Yu-Dong Gu

the same hemisphere, there can be long-range plasticity between cortical hemispheres. Most of the evidence comes from studies of direct cortical damage, such as stroke or cortical lesions in human and animal models. 1 , 4 , 8 , 25 Some studies have also explored interhemispheric cortical plasticity after peripheral nerve deafferentation, but little long-term motor cortex plasticity was involved. Brachial plexus root avulsion injury is a severe peripheral nerve deafferentation in which the nerves that bridge the CNS and one side of the upper limb are ruptured. The

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Xu-Yun Hua, Bin Liu, Yan-Qun Qiu, Wei-Jun Tang, Wen-Dong Xu, Han-Qiu Liu, Jian-Guang Xu and Yu-Dong Gu

approved by the Medical Committee. All patients had complete avulsion of the 5 roots of the upper limb diagnosed by clinical evaluation and electromyography studies before surgery. During the surgical treatment the whole brachial plexus was exposed, and a definitive diagnosis of root avulsions was made at operation because the C5–T1 nerve within the intervertebral foramen was absent. The nerve transfer operation was performed with contralateral C-7 root to the median nerve of the damaged brachial plexus. The ulnar nerve of the damaged limb was used to perform grafting

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Cheng-Gang Zhang, Zhen Dong and Yu-Dong Gu

T1 or C8, T1 root avulsions: a new technique . Tech Hand Up Extrem Surg 10 : 252 – 254 , 2006 6 Gu Y , Wang H , Zhang L , Zhang G , Zhao X , Chen L : Transfer of brachialis branch of musculocutaneous nerve for finger flexion: anatomic study and case report . Microsurgery 24 : 358 – 362 , 2004 7 Oberlin C , Teboul F , Severin S , Beaulieu JY : Transfer of the lateral cutaneous nerve of the forearm to the dorsal branch of the ulnar nerve, for providing sensation on the ulnar aspect of the hand . Plast Reconstr Surg 112

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Bin Xu, Zhen Dong, Cheng-Gang Zhang and Yu-Dong Gu

if necessary, we selected the brachialis motor branch and PT branch as potential donor nerves. We sought to transfer the PT branch to the AIN and the brachialis motor branch to the FDS branch for reinnervation of both the FPL/FDP and the FDS, respectively. In the present study we evaluated the results of these combined nerve and tendon transfers in C7–T1 brachial plexus avulsions. The first-stage operation involved nerve transfer of 1) the PT branch to the AIN, 2) the brachialis motor branch to the FDS branch with a nerve graft, and 3) the supinator motor branch to

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Guo-Bao Wang, Ai-Ping Yu, Chye Yew Ng, Gao-Wei Lei, Xiao-Min Wang, Yan-Qun Qiu, Jun-Tao Feng, Tie Li, Qing-Zhong Chen, Qian-Ru He, Fei Ding, Shu-Sen Cui, Yu-Dong Gu, Jian-Guang Xu, Su Jiang and Wen-Dong Xu

total root avulsion was confirmed during surgical exploration. All procedures were performed by the senior author (W.D.X.). All patients underwent CC7 to C7 nerve transfer, in addition to other nerve transfers, as part of the overall reconstructive plan. Of the 8 patients, 1 was lost to follow-up and 1 was excluded because of severe concomitant soft-tissue damage of the arm. Among the remaining 6 patients, 5 were male and 1 was female, and the mean age was 27.2 ± 9.0 years (range 18–43 years). The average interval from injury to operation was 2 ± 0.6 months (range 1