|| FIG. 45-12. In the event of a significant loss of substance between the C5/C6 roots and the lateral cord, the vascularized ulnar nerve is transferred microsurgically to bridge the gap.
FIG. 45-13. If free transfer of the vascularized ulnar nerve is not possible, this nerve can be pedicled on the proximal collateral ulnar artery originating in the axillary artery.
FIG. 45-14. Rupture of C5 with intradural avulsion of C6, C7, C8, and TI. The suprascapularis nerve is neurotized by the spinal accessory nerve. C6 is grafted to the musculocutaneous nerve and to the radial nerve.
FIG. 45-15. Complete avulsion of the brachial plexus. The biceps nerve is neurotized by the spinal accessory nerve. The medial cord is neurotized using three intercostal nerves. An alternate solution is to neurotize the suprascapularis nerve by the spinal accessory nerve and the biceps nerve by intercostal nerves.
FIG. 45-16. Complete deltoid palsy on the right side, by rupture of the axillary nerve at the lateral aspect of the scapula. A dual surgical approach (deltopectoral and posterior) is used to graft the axillary nerve along 7 cm in a "push-pull" manner.
FIG. 45-17. Appearance of the axillary nerve ruptured in its proximal portion. The nerves of the teres major and of the thoracodorsalis muscle are usually intact.
FIG. 45-18. A vertical incision along the medial aspect of the posterior portion of the deltoid muscle provides access to the distal extremity of the axillary nerve.
FIG. 45-19. Results 9 months after graft. Shoulder extension is full at M4. Front view.
FIG. 45-20. Rear view.
FIG. 45-21. Side view.