The extraplexal neurotisation (nerve transfer) refers to the use of donor nerves that originate outside the brachial plexus in order to repair injuries of the brachial plexus. Reconstructive microsurgery offers the possibility of using intact nerves as donors (as for example the use of the sural nerve from the lower leg as a donor) in order to reconstruct dissected and injured parts of the brachial plexus. A classic example of an extraplexal nerve transfer is the so called intercostal transfer. In this case, an injured biceps muscle with a non- functional bending capability of the elbow can receive impulses from the intercostal nerves (nerves located between the ribs). This is accomplished by rerouting intact intercostal nerves (that are located outside the brachial plexus and are thus characterized as extraplexal) on the biceps nerve (musculocutaneous) and with the use of the operational microscope microsurgical sew these nerves together (1). Since not all intercostal nerves are being used (as a rule three up to four can be used) the overall function of the intercostal nerves remains unaffected. By this way modern plastic surgery can offer a good treatment option in the case of a non-functional elbow after a lesion of the brachial plexus. Another example of an extraplexal nerve transfer is the transfer of the nerve of the neck (accessory nerve that terminates on the trapezius muscle). The accessory nerve displays two side branches. One of these two branches could be used to innervate the nerve of the shoulder (suprascapular) while retaining the neck muscle function (shrugging the shoulders towards the ears). In this way important aspects of the function of the shoulder and its stability can be reconstructed.


(1)http://onlinelibrary.wiley.com/doi/10.1002/micr.20583/abstract

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