A Cadaveric Micro-Anatomic Study of Intra-Fascicular Topography of Brachial PlexusKeywords: brachial plexus, graft, nerve, cadaver dissection, Peripheral NerveInteractive Manuscript
Ask Questions of this Manuscript:
What is the background behind your study?
Peripheral nerve organization in the brachial plexus is important.
What is the purpose of your study?
The aim was to study fascicular topography of brachial plexus.
Describe your patient group.
Brachial plexus of 10 adult male cadavers was dissected .
Describe what you did.
All roots were tagged on ventral aspects by 10-0 nylon, about 5 mm distal to exit from foramen. The fixed specimens were dissected and interfascicular longitudinal dissection performed under microscope. The dissection was conducted proximally to the level of the nylon stitch and distally till the plexal branches. The area occupied by different nerve fascicles was then expressed as percentage of the total cross-sectional area of the roots.
Describe your main findings.
The suprascapular nerve derived its fibers mainly from C5, occupying 49% of the total cross-sectional area, between 9 o’clock and 12 o’clock from the surgeon’s intraoperative perspective. In C8 root, medial root of median nerve and ulnar nerve occupied 86% area. In T1 root, medial cutaneous nerve of arm, medial cutaneous nerve of forearm and medial pectoral nerve occupied 36% area, while the rest of area was occupied by ulnar fascicles in the middle (37%) and medial root of median nerve (23%).
Describe the main limitation of this study.
This is a cadaver study.
Describe your main conclusion.
In plexal reconstruction with nerve grafts, coaptation should be performed only in area of the related fascicles.
Describe the importance of your findings and how they can be used by others.
This will minimize axonal misrouting and may improve outcome.
Peripheral nerve organization in the brachial plexus is important.
The aim was to study fascicular topography of brachial plexus.
Brachial plexus of 10 adult male cadavers was dissected .
All roots were tagged on ventral aspects by 10-0 nylon, about 5 mm distal to exit from foramen. The fixed specimens were dissected and interfascicular longitudinal dissection performed under microscope. The dissection was conducted proximally to the level of the nylon stitch and distally till the plexal branches. The area occupied by different nerve fascicles was then expressed as percentage of the total cross-sectional area of the roots.
The suprascapular nerve derived its fibers mainly from C5, occupying 49% of the total cross-sectional area, between 9 o’clock and 12 o’clock from the surgeon’s intraoperative perspective. In C8 root, medial root of median nerve and ulnar nerve occupied 86% area. In T1 root, medial cutaneous nerve of arm, medial cutaneous nerve of forearm and medial pectoral nerve occupied 36% area, while the rest of area was occupied by ulnar fascicles in the middle (37%) and medial root of median nerve (23%).
This is a cadaver study.
In plexal reconstruction with nerve grafts, coaptation should be performed only in area of the related fascicles.
This will minimize axonal misrouting and may improve outcome.
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