1. In the name of Allah

2. Reza Sh. Kamrani Ortopaedic surgeon Hand surgeon TUMS 16 th Iranian Ortopaedic Surgeon Association Congress, Hand surgery symposium 9 / 8 /1387 Tehran IRAN

3.  Neurotization  Definition  History  Nerve transfer

4.  Nerve transfer in Brachial Plexus Birth Palsy  Classic transfer in brachial plexus .  New concepts in nerve transfer ?

5.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in brachial plexus (When?) .When nerve root is avulsed .When nerve graft is not possible .. ..  New concepts in nerve transfer

6.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in brachial plexus (How?) .Which function (root/trunk/branch) is in priority ? .Which donor nerve is our choice ? .. ..  New concepts in nerve transfer

7.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in upper brachial plexus .Which function (root/trunk/branch) is in priority .Which donor nerve is our choice .  New concepts in nerve transfer Elbow flexion Lateral cord MC Shoulder abd. Sup.Scap Axill.

8.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in upper brachial plexus .Which function (root/trunk/branch) is in priority .Which donor nerve is our choice .  New concepts in nerve transfer Oberlin Mod. Oberlin Radial? Accessory Radial ICN.

9. Accessory to Sup. Scapular Median to biceps Ulna to brachialis

10. Accessory to Sup. Scapular

11.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in whole brachial plexus .Which function (root/trunk/branch) is in priority .Which donor nerve is our choice .  New concepts in nerve transfer Elbow flexion Wrist and finger function Shoulder stability Sensation of medial border of the hand

12.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in whole brachial plexus .Which function (root/trunk/branch) is in priority .Which donor nerve is our choice .  New concepts in nerve transfer Accessory / Pherenic Wrist and finger function Shoulder stability Sensation of medial border of the hand

13.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in whole brachial plexus .Which function (root/trunk/branch) is in priority .Which donor nerve is our choice .  New concepts in nerve transfer Accessory / Pherenic Wrist and finger function Pherenic / Accessory Sensation of medial border of the hand

14.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in whole brachial plexus .Which function (root/trunk/branch) is in priority .Which donor nerve is our choice .  New concepts in nerve transfer Accessory / Pherenic Pherenic / Accessory Contralateral C7 + vascularized ulna /ICN to Median

15. Acc. +graft to MC Pherenic to Sup. Scapular

16. Contralateral C7 + ulna to Median

17.  ICN

18.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in brachial plexus .When nerve root is avulsed .When nerve graft is not possible .  New concepts in nerve transfer

29.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in brachial plexus .When nerve root is avulsed .When nerve graft is not possible .  New concepts in nerve transfer

31.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in brachial plexus .When nerve root is avulsed .When nerve graft is not possible  New concepts in nerve transfer

32.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in brachial plexus .  New concepts in nerve transfer .Even in ruptured roots .Even in more distal injuries ? .Even in penetrating injury ??

33.  Classic  Nerve graft and plexus reconstruction whenever possible  New concept  Primary nerve transfer

34. PANNUPANOBERLIN

35. PANNUPANOBERLIN  Acc. to Sup. Scap  Mod. Oberlin  Rad. To Axill  Shoulder arthrodesis (manual worker)  ICN to Triceps (C5-7)  Pherenic to Sup. Scap  Oberlin

36. PANNUPANOBERLIN  Pherenic to Sup. Scap  Acc.+graft to MC  Contralat C7+ vascularized ulna to Median  Classic plexus reconstruction

37.  Nerve transfer in Brachial Plexus Inj.  Classic transfer in brachial plexus .  New concepts in nerve transfer

38.  Nerve transfer in Brachial Plexus Birth Palsy  Classic transfer in brachial plexus .  New concepts in nerve transfer ?

40. ADULT BP INJ.OBSTETRIC BP INJ.  Adult  Infant  Shorter regeneration distance  Stronger potential for regeneration  Greater capacity for brain adaptation

42. ADULT BP INJ.OBSTETRIC BP INJ.  Goal

43. ADULT BP INJ.OBSTETRIC BP INJ.  Goal  Elbow flexion  Shoulder stability  Goal  Elbow flexion  Shoulder reanimation

44. ADULT BP INJ.OBSTETRIC BP INJ.  Goal  Elbow flexion  Shoulder stability  Medial border sensation  Wrist and finger function  Intrinsic function  Goal  Hand function  Elbow flexion  Shoulder reanimation

45. ADULT BP INJ.OBSTETRIC BP INJ.  Classic nerve transfer .Intra plexus  Avulsion is more common ..  New concept  Classic nerve transfer .Intra plexus  Avulsion is less common ..  New concept

46. ADULT BP INJ.OBSTETRIC BP INJ.  Classic nerve transfer .Intra plexus  Avulsion is more common .Extra plexus  Pherenic is available  Ulna can be sacrifized  New concept  Classic nerve transfer .Intra plexus  Avulsion is less common .Extra plexus  Pherenic is forbiden  Ulna must be reconstruct  New concept

47. ADULT BP INJ.OBSTETRIC BP INJ.  Classic nerve transfer  Intra plexus .C5 to upper trunk .C6 to middle trunk .C5/C6 Lateral cord/ Medial cord  ICN+Pherenic adding  New concept  Classic nerve transfer  Intra plexus .C5 to C8T1 .C6 to .Acc. To Sup. Scap  ICN adding  New concept

49. ADULT BP INJ.OBSTETRIC BP INJ.  Classic nerve transfer  Extra plexus .Pherenic to Sup. Scap .Acc. To MC .Contra lateral C7 to Median  ICN adding  New concept  Classic nerve transfer  Extra plexus .Acc. To Sup. Scap  ICN+ contralat C7 to median-ulna-radial  New concept

50. ADULT BP INJ.OBSTETRIC BP INJ.  Classic nerve transfer .Acc. To Sup. Scap .Mod Oberlin .Rad. To Axill  New concept  Classic nerve transfer .RARE .Acc. to Sup. Scap .Oberlin  New concept

53. ADULT BP INJ.OBSTETRIC BP INJ.  Classic nerve transfer .. .. ..  New concept  Becomes more and more popular  Classic nerve transfer .. .. ..  New concept  It is not pronounced  Acc. To Sup. Scap may be exception

57. Currently in Obstetric BPI classic nerve transfer is the prefer method as Professor Gilbert was described Future ?

58. Thank you for your attention