Enrico Martin

215 Nerve reconstructions in extremity STS resection of the upper trunk after neoadjuvant radiotherapy. 30 Subsequently, sural nerve interposition grafts were placed from C5 to the anterior division of the upper trunk. Secondly, the spinal accessory nerve was connected to the suprascapular nerve using a sural nerve graft. Lastly, to optimize abduction, a radial branch to the long head of the triceps, was sutured to the non-functional axillary nerve. The reconstruction yielded excellent elbow flexion and shoulder abduction, even some sensation in C5-6 was achieved at 36 months postoperatively, all despite neoadjuvant radiotherapy. The second case described an en bloc excision of the brachial plexus, after which the patient was left with a flail arm. To restore function, an ulnar nerve graft was used to connect the radial nerve to both C5 and C7 roots, a sural nerve graft was placed between C5 and the median nerve, and the 4 th to 6 th intercostal nerves were harvested and anastomosed to the musculocutaneous nerve. Despite these efforts the patient remained paralysed. 31 Median nerve The resection and reconstruction of a median nerve was described in four case reports. 32–35 All defects occurred in the proximal forearm. Three defects were reconstructed with the use of grafts, 33–35 the other with a transfer of the superficial radial nerve (RSN). 32 Sensation was restored adequately in all patients (protective or S3+-S4). Grasp power or finger flexion were recorded in three patients, of which all were functional. 32,34,35 Loss of motor function was reconstructed with tendon transfers and a free functioning muscle transfer. 32,34 In one case wrist flexion was reconstructed with a partial ulnar nerve transfer to the flexors, however no postoperative muscle grade was measured. 33 All reconstructions were successful albeit the use of neoadjuvant radiotherapy in one patient 34 and a combination of adjuvant and neoadjuvant administration of chemotherapy in another. 32 Radial nerve The reconstruction of the radial nerve was described in three case reports. 36–38 Two defects were at the level of the hand, 37,38 while the other was more proximal. 36 All nerve reconstructions used grafts and were performed for reversal of sensory loss. Either the lateral antebrachial cutaneous nerve (LABCN) or sural nerve was used as grafts. Recovery of sensation was good (S3-S3+) in both cases reporting an objective outcome. 36,37 Subjective outcome measures were excellent in both studies describing this. 37,38 Motor defects were reconstructed with tendon grafts in one case. 37 Two cases received radiotherapy, of which one was brachytherapy; both cases had good outcomes. 37,38 9