Exploration of Fascicular Shift Procedure
Over the last decade, a number of models have investigated the use of different biologic and synthetic matrices as alternatives to conventional nerve grafts. Still the autologous nerve graft is the gold standard, even though here a pure sensory nerve is often used to reconstruct a mixed nerve. It has become evident that mixed nerves have a higher functional outcome when being reconstructed with like nerve grafts. We present a new concept in the reconstruction of large proximal nerve defects that overcomes this problem: the fascicular shift. Here a fascicle group of the nerve segment distal to the injury site is harvested in appropriate length to bridge the injury site.
Quantification of Sensory/Motor Nerve Fibers of the Brachial Plexus in Man
Nerve fibers supplying the upper extremity leave the spinal cord from the four caudal cervical roots (C5 – C8) and the first thoracic root (Th1). These fibers experience an intense rearrangement of their position in the proximal part of the peripheral nerves, which is called the brachial plexus. Before reaching the axilla the brachial plexus splits up in its five terminal branches. The fibers within the nerves can be separated into two basic categories, namely either sensory- (afferent) or motor fibers (efferent). Afferent fibers enter the spinal cord via the dorsal root whereas the efferent fibers leave the central nervous system via the ventral root. This classic distinction was first described in the early 19 century by Bell and Magendie (“Law of Bell and Magendie”). On the molecular level the efferent fibers can be distinguished from the afferent fibers by the exclusive presence of Choline acetyltransferase (ChAT) in efferent fibers. To the present day it is not known how many efferent fibers supply the upper extremity. Therefore, the aim of this project is the absolute quantification of efferent fibers of this particular body part.