Shoulder abduction is a very complex movement and quite important for upper limb function, as more distal functions depend on a stable shoulder, especially in C5, C6 brachial plexus injuries. Various studies in the literature have emphasized the importance of improved functional outcome and shoulder reanimation with concomitant neurotization of suprascapular nerve and axillary nerve in C5, C6 brachial plexus injuries. A number of approaches to axillary nerve transfer in brachial plexus injuries have been reported. The author describes an innovative anterior deltopectoral approach for axillary nerve transfers in five patients with C5, C6 brachial plexus injuries. The spinal accessory nerve was neurotized with the suprascapular nerve through a transverse supraclavicular incision. The axillary nerve and the long head of the triceps branch were identified through the anterior deltopectoral approach and neurotized at the posterior cord level. This approach gives easy access to other donors such as the medial pectoral, thoracodorsal, and median and ulnar nerves. Oberlin's transfer was also performed for elbow flexion by extending the deltopectoral incision. The regained shoulder active abduction (M5) averaged 120 degrees and active external rotation averaged 65 degrees at the final follow-up of 26 months (average). This anterior deltopectoral approach is an excellent alternative for axillary nerve transfer in brachial plexus injuries and produces results comparable with those of other approaches. All brachial plexus surgeons must understand the anatomy and the relationship of the axillary nerve to the surrounding structures. Therapeutic, V.

Background: Fingertip injury reconstruction aims to restore function and appearance. We report our new fingertip injuries outcome score (FIOS) based on finger length, bone consolidation, nail aesthetics, sensation, range of motion, grip strength, and return to work to evaluate the functional outcome of fingertip injuries. Methods: We analyzed the reliability and validity of the FIOS in 199 fingertip injuries of varying size, shape, and contours involving soft tissues and the bone. Semi-occlusive dressings and various reconstructive procedures were done based on the geometry. The FIOS had 10 items and specific scores. Results: The mean follow-up of our study was 26.8 months (range, 18–66 months). We classified the results based on the FIOS. A value of 12 or more is considered excellent; 13–18 is good; 19–24 is fair; and greater than 24 is poor. Excellent or good results were achieved in 186 cases. Nine cases had fair results, and four had poor results. We found the FIOS significantly reliable, consistent (Cronbach’s alpha 0.796), reproducible, and valid (ANOVA P < 0.05). Conclusions: FIOS is a simple, reliable, and meaningful method to assess the outcome of fingertip injuries. It is clinically relevant and remains a comparison tool for evaluating the efficiencies of treatment.

Purpose.: To report outcome of axillary nerve neurotisation for brachial plexus injury through the anterior deltopectoral approach. Methods.: Nine men aged 20 to 52 (mean, 27.8) years with brachial plexus injury underwent axillary nerve neurotisation through the anterior deltopectoral approach. Three of the patients had complete avulsion of C5-T1 nerve roots. The remaining 6 patients had brachial plexus injury of C5-C6 nerve roots, with associated subluxation of the glenohumeral joint, atrophy of the supraspinatus, deltoid and elbow flexors. They had no active shoulder abduction, external rotation, and elbow flexion. The pectoralis major and minor were cut and/or retracted to expose the underlying infraclavicular plexus. The axillary nerve was identified with respect to the available donor nerves (long head of triceps branch, thoracodorsal nerve, and medial pectoral nerve). In addition to the axillary nerve neurotisation, each patient had a spinal accessory nerve transferred to the suprascapular nerve for better shoulder animation. Results.: Patients were followed up for 24 to 30 (mean, 26) months. In the 3 patients with C5-T1 nerve root injuries, the mean active abduction and external rotation were 63° and 20°, respectively, whereas the mean abduction strength was M3 (motion against gravity). In the 6 patients with C5-C6 nerve root injuries, the mean active abduction and external rotation were 133° and 65°, respectively, whereas the strength of the deltoids and triceps was M5 (normal) in all. In 4 patients with the pectoralis major cut and repaired, the muscle regained normal strength. Conclusion.: The anterior deltopectoral approach enabled easy access to all available donor nerves for axillary nerve neurotisation and achieved good outcomes.