Anatomic study and clinical application of double- branched thoracodorsal nerve / 中华骨科杂志

ABSTRACT

Objective To study the lateral branch of thoracodorsal nerve and the deltoid branch of axillary nerve under microscope for clinical application in the reconstruction of brachial nerve injury. Methods 31 lateral branches and deltoid branches of axillary nerve on 17 cadaver specimens were studied on topography under the light microscope(? 5) to observe the length, diameter, and the number of branches. The number of fibers was counted on the HE- stained section of the nerves. Three cases were performed: In operationⅠ , the lateral branch of thoracodorsal nerve was connected with the deltoid branch of axillary nerve. In operationⅡ , on the base of the first operation, the medial branches of the thoracodorsal nerve partially the latissimus dorsi was reconstructed for recovery of the flexion function of the elbow. In operationⅢ , the latissimus dorsi was section into two parts according to the innervation of the medial and lateral branches of the thoracodorsal, and the two branches of the thoracodorsal were transplanted in a dislplaced position for the restoration of flexion function of the elbow and the fingers. Results Thoracodorsal nerves have 2 branches near dorsal aspect of the latissimus dorsi. The lateral branch is thicker with the average length of 58.2 mm avaliable for the reconstruction purpose; the diameter is in average of 1.46 mm, the number of fibers is in average of 1 519; 90.4％ of the lateral branches redivided into 2 or 3 branches. The diameter of the deltoid branch of axillary nerve is 2.31 mm in average and 61.3％ give 3 branches; 32.3％ 2 branches; the number of fibers is in average of 2 341. Clinically the reconstruction operation is successful. In operationⅠ the strength of the deltoid muscle recovered to grade 4; in operationⅡ the strength of the deltoid muscle and elbow- flexing is reached grade 4 and in operationⅢ the strength of elbow- and finger- flexion recovered to grade 4. Conclusion Reconstruction of two muscular groups of the latissimus dorsi with loss of nerve innervation is effective by the application of double branch potential of the thoracodorsal nerve.