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  • 66
  • 2014-03-07

Neurotisation to the axillary nerve by the nerve to the triceps

Epublication WebSurg.com, Mar 2014;14(03). URL:
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Nerve transfer to the deltoid muscle using the nerve of the long head of the triceps is a reliable method for deltoid function restoration. The aim of this retrospective study was to report the results of the nerve transfer procedure to the deltoid muscle using the nerve of the long head of the triceps by means of a robot. Our series included six patients (mean age: 36.3 years) with total deltoid muscle paralysis. A da Vinci S® robot was placed in position. After dissection of the quadrilateral and triangular spaces, the anterior branch of the axillary nerve and the branch to the long head of the triceps were transected, then robotically sutured with two 10/0 Nylon stitches. In 2 cases, an endoscopic procedure was attempted under carbon dioxide insufflation. In all patients except one, deltoid function against resistance (M4) was obtained at the last follow-up evaluation. The average shoulder abduction was 112 degrees. No elbow extension weakness was observed. In 2 cases with the endoscopic technique, vision was blurred and conversion to the open technique was performed. The advantages of robotic microsurgery are motion scaling and disappearance of physiological tremors. Reasons for failure of the endoscopic technique could be explained by insufficient pressure. We had no difficulty using the robot without sensory feedback. The robot-assisted nerve transfer to the deltoid muscle using the nerve of the long head of the triceps was a feasible application for restoration of shoulder abduction after brachial plexus or axillary nerve injury.