1. Mikhail L. Novikov, M.D., Timur E. Torno, M.D. Yaroslavl, Russia
Use of intercostal nerves in treatment of complete brachial plexus palsy
Mikhail L. Novikov, M.D., Timur E. Torno, M.D.
Yaroslavl, Russia

2. Introduction
The Intercostal nerves (ICNs) are a well-known donors for brachial plexus (BP) reconstructions
Most common target for ICNs transfer is elbow flexion in cases of complete (total) BPP  
However, there are some controversies concerning the different technique versions

3. Material and methods
2005 – patients with BPP underwent ICN transfers (40 adults and 8 children)
ICNs to MC nerve or its branches - 37 cases
ICNs to obturator nerve (free gracilis) - 11 cases

4. Basic principles of ICNs to MC nerve transfer
Direct cooptation of ICNs and MC
Two targets for elbow flexion: Biceps and Brachialis muscles
4 or 5 ICNs to match entire crossection of MC
Fibrin glue allows to bring tiny ICNs together in one solid fascicle
Branches of MC to brachialis muscle and lateral antebrachial cutaneous nerve (LAC) become potential axon donors 

5. ICNs to MC transfer

6. LAC can be connected with fascicules of the radial nerve correspondent to its branches to
BR and ECRL, ECRB

7. Secondary reconstructions with ICNs
Branches of MC to brachialis muscle previously neurotized by ICNs were utilized in 5 patients with free gracilis muscle transfer

8. Free m.gracilis transfer for finger flexion neurotized by brachialis branch of MC following ICNs to MC transfer

9. The patient 4 years after free gracilis with MC branch to brachialis for finger flexion

10. OBPP patient at age 4 underwent free gracilis transfer with ICNs for elbow flexion and wrist extension

11. OBPP patient at age 4 underwent free gracilis transfer with ICNs for elbow flexion and wrist extension

12. Conclusion ICNs are effective donors for BP reconstructions
Proper number of ICNs should be used during primary surgery considering them as potential source of axons for secondary reconstruction
Free microsurgical muscle transfer neurotized by ICNs can provide some useful degree of hand function

13. Thank you for your attention