autologous-nerve-grafting-versus-multiple-nerve-transfers-for-upper

Autologous Nerve Grafting Versus Multiple Nerve Transfers for Upper Trunk Brachial Plexus Injury: A Rat Model Study

Upper trunk (C5-C6) injuries of the brachial plexus impair shoulder abduction and elbow flexion. For C5-C6 ruptures with preserved proximal stumps, nerve ...

Fudan University

NHC Key Laboratory of Hand Reconstruction (Fudan University)

Shanghai Key Laboratory of Peripheral Nerve and Microsurgery

There are no biological marks to indicate if denervated muscle atrophy after nerve injury is irreversible. Clinically in obstetric brachial plexus palsy (OBPP), atrophy of denervated intrinsic musculature of the hand is much faster to irreversible than that of denervated muscles of the arm. 64 pup rats whose C5C6 had been divided and C7C8T1 avulsed, were divided equally into the reconstruction and control groups. The former had subgroups R1, R5, R10, R15 where the ulnar and musculocutaneous nerves were reconstructed one, five, ten and 15 weeks respectively after injury and efficacy was evaluated 12 weeks later. The latter had C1, C5, C10, C15 subgroups where denervated muscles of the two nerves were assessed one, five, ten and 15 weeks after injury. Results of average cross-sectional area of the muscle fiber for intrinsic musculature of the forepaw showed that the R5, R10, R15 subgroups were not statistically superior to the C5, C10, C15 ones, respectively, though R1 was; those for biceps indicated, however, that the R1, R5, R10 subgroups were better than the C1, C5, C10 ones, respectively, though R15 was not. In the reconstruction subgroups regenerative nerve fibers in each nerve were no less than 53 percent of those on the control side, while number of motor end plates was statistically less in subgroups with irreversible muscle atrophy. We conclude that rat model of OBPP is suitable for simulating clinical appearance of atrophy of denervated intrinsic musculature of the hand being faster than that of denervated muscles of the arm.

A rat model study of atrophy of denervated musculature of the hand being faster than that of denervated muscles of the arm.

In obstetric brachial plexus palsy (OBPP), irreversible muscle atrophy occurs much faster in intrinsic muscles of the hand than in the biceps. To elucidate the mechanisms involved, mRNA expression profiles of denervated intrinsic muscles of the forepaw (IMF) and denervated biceps were determined by microarray using the rat model of OBPP where atrophy of IMF is irreversible while atrophy of biceps is reversible. Relative to contralateral control, 446 dysregulated mRNAs were detected in denervated IMF and mapped to 51 KEGG pathways, and 830 dysregulated mRNAs were detected in denervated biceps and mapped to 52 KEGG pathways. In denervated IMF, 10 of the pathways were related to muscle regulation; six with down-regulated and one with up-regulated mRNAs. The remaining three pathways had both up- and down-regulated mRNAs. In denervated biceps, 13 of the pathways were related to muscle regulation, six with up-regulated and seven with down-regulated mRNAs. Five of the pathways with up-regulated mRNAs were related to regrowth and differentiation of muscle cells. Among the 23 pathways with dysregulated mRNAs, 13 were involved in regulation of neuromuscular junctions. Our results demonstrated that mRNAs expression characteristics in irreversibly atrophic denervated IMF were different from those in reversibly atrophic denervated biceps; dysregulated mRNAs in IMF were associated with inactive pathways of muscle regulation, and in biceps they were associated with active pathways of regrowth and differentiation. Lack of self-repair potential in IMF may be a major reason why atrophy of IMF becomes irreversible much faster than atrophy of biceps after denervation.

mRNA expression characteristics are different in irreversibly atrophic intrinsic muscles of the forepaw compared with reversibly atrophic biceps in a rat model of obstetric brachial plexus palsy (OBPP).

To compare the long-term results of transfers of the ipsilateral C7 (IC7) plus spinal accessory nerve (SAN) with those of triple nerve transfers (TNT) using one fascicle of the ulnar nerve to the biceps motor branch (Oberlin's procedure), SAN transferred to the suprascapular nerve, and transfer of the long head of triceps nerve branch to the anterior branch of axillary nerve to treat C5-C6 avulsion of the brachial plexus.

Transfers of the Ipsilateral C7 Plus the Spinal Accessory Nerve Versus Triple Nerve Transfers for Treatment of C5-C6 Avulsion of the Brachial Plexus.

In treating patients with obstetric brachial plexus palsy, we noticed that denervated intrinsic muscles of the hand become irreversibly atrophic at a faster than denervated biceps. In a rat model of obstetric brachial plexus palsy, denervated intrinsic musculature of the forepaw entered the irreversible atrophy far earlier than denervated biceps. In this study, isobaric tags for relative and absolute quantitation were examined in the intrinsic musculature of forepaw and biceps on denervated and normal sides at 3 and 5 weeks to identify dysregulated proteins. Enrichment of pathways mapped by those proteins was analyzed by Kyoto Encyclopedia of Genes and Genomes analysis. At 3 weeks, 119 dysregulated proteins in denervated intrinsic musculature of the forepaw were mapped to nine pathways for muscle regulation, while 67 dysregulated proteins were mapped to three such pathways at 5 weeks. At 3 weeks, 27 upregulated proteins were mapped to five pathways involving inflammation and apoptosis, while two upregulated proteins were mapped to one such pathway at 5 weeks. At 3 and 5 weeks, 53 proteins from pathways involving regrowth and differentiation were downregulated. At 3 weeks, 64 dysregulated proteins in denervated biceps were mapped to five pathways involving muscle regulation, while, five dysregulated proteins were mapped to three such pathways at 5 weeks. One protein mapped to inflammation and apoptotic pathways was upregulated from one pathway at 3 weeks, while three proteins were downregulated from two other pathways at 5 weeks. Four proteins mapped to regrowth and differentiation pathways were upregulated from three pathways at 3 weeks, while two proteins were downregulated in another pathway at 5 weeks. These results implicated inflammation and apoptosis as critical factors aggravating atrophy of denervated intrinsic muscles of the hand during obstetric brachial plexus palsy. All experimental procedures and protocols were approved by the Experimental Animal Ethics Committee of Fudan University, China (approval No. DF-325) in January 2015.

Inflammation and apoptosis accelerate progression to irreversible atrophy in denervated intrinsic muscles of the hand compared with biceps: proteomic analysis of a rat model of obstetric brachial plexus palsy.

Injuries to the upper and middle trunks of brachial plexus result in dysfunction of radial nerves in newborns but do not in adults. We hypothesized that the radial nerve had a lower proportion of myelinated nerve fibers (MNFs) from the lower trunk in newborns than in adults, and in newborns those MNFs were less developed than MNFs in the radial nerve from the middle and upper trunks.

Morphological basis of radial nerve dysfunction in newborns differs from that of no radial nerve dysfunction in adults in C5-C6-C7 injuries to the brachial plexus: a cadaveric study.

To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.

Article	Year
A rat model study of atrophy of denervated musculature of the hand being faster than that of denervated muscles of the arm. Journal of muscle research and cell motility\| PubMed ID: 23065138	2013
mRNA expression characteristics are different in irreversibly atrophic intrinsic muscles of the forepaw compared with reversibly atrophic biceps in a rat model of obstetric brachial plexus p... Journal of muscle research and cell motility\| PubMed ID: 26902607	2016
Transfers of the Ipsilateral C7 Plus the Spinal Accessory Nerve Versus Triple Nerve Transfers for Treatment of C5-C6 Avulsion of the Brachial Plexus. The Journal of hand surgery\| PubMed ID: 31718845	2020
Inflammation and apoptosis accelerate progression to irreversible atrophy in denervated intrinsic muscles of the hand compared with biceps: proteomic analysis of a rat model of obstetric bra... Neural regeneration research\| PubMed ID: 31960820	2020
Morphological basis of radial nerve dysfunction in newborns differs from that of no radial nerve dysfunction in adults in C5-C6-C7 injuries to the brachial plexus: a cadaveric study. British journal of neurosurgery\| PubMed ID: 34259110	2021
[Clinical analysis of distal radius core decompression for chronic wrist pain]. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery\| PubMed ID: 37460177	2023

Jixin Wu

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