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“BACKGROUND: Current methods for the restoration of wrist and digit extension after a complete brachial plexus injury result in poor outcomes.

OBJECTIVE: To determine the internal topography of the

radial nerve in the axilla and present a method for selective neurotization of the radial nerve using a full-length phrenic nerve.

METHODS: Internal topographic features of the fascicular groups of the radial nerve were observed at the level of latissimus dorsi insertion in 16 cadavers. Selective neurotization of the medial portion of the antebrachial part of the main trunk of the radial nerve was performed at this level using a full-length phrenic nerve in one patient with complete brachial plexus palsy.

RESULTS: At the level of latissimus dorsi insertion in the axilla, the antebrachial selleck SU5402 in vivo part of the radial nerve, which innervates the forearm extensors, is located at the superior lateral part of the radial nerve trunk. It can be divided into medial and lateral portions. Transfer of a full-length phrenic nerve was used to selectively reinnervate the medial portion of the antebrachial part of the radial nerve in 1 patient with complete brachial plexus palsy. The patient’s antebrachial extensor muscles regained Grade 4 power when assessed 3 years after surgery.

CONCLUSION: The fibers that innervate the antebrachial extensors are located at the superior lateral part of the radial nerve

trunk in the axilla. Selective neurotization of the radial nerve at this level with a phrenic nerve was performed successfully in 1 patient.”
“The coronary and extracranial carotid vascular beds are often simultaneously affected by significant atherosclerotic disease, and stroke is one of the potential major complications of coronary artery surgery. As a result, there is no shortage of reports in the vascular surgery literature describing simultaneous coronary and carotid artery revascularizations. Generally, these reports have found this combination of operations safe, but have stopped short of proving that it is necessary. Intuitively, simultaneous carotid endarterectomy

and coronary artery bypass surgery could be justified if most perioperative strokes were the result of a significant carotid stenosis, either directly or indirectly. At first glance this appears to be a fairly Cyclopamine solubility dmso straightforward issue; however, much of the evidence on both sides of the argument is circumstantial. One significant problem in analyzing outcome by choice of treatment in patients presenting with both coronary and carotid disease is the multiple potential causes of stroke in coronary bypass patients, which include hemorrhage and atheroemboli from aortic atheromas during clamping. But this controversial subject is now open to discussion, and our debaters have been given the challenge to clarify the evidence to justify their claims. (J Vasc Surg 2010;52:1716-21.