Ajul Shah, MD, FACS
Board Certified Plastic and Reconstructive Surgeon
Sub-specialty Board Certified Hand and Upper Extremity Surgery
Co-Founder, ARMS Center
Introduction
Intraoperative nerve stimulation has proven to be a critical component in performing reliable and reproducible nerve reconstructive procedures, namely nerve transfers. Rather than relying solely on the predicted intraneural topography of the donor nerve, intraoperative nerve stimulation allows for more facile fascicular identification, offering the peripheral nerve surgeon more confidence in the donor harvest. This provides not only a more predictable outcome from the transfer itself, but also allows for limitation in donor morbidity.
Until recently, the use of CHECKPOINT GUARDIAN® Monopolar Nerve Stimulator was the only available option for repeated intraoperative nerve identification. However, with the advent of CHECKPOINT GEMINI® Bipolar Nerve Stimulator, surgeons are now able to harness the specificity of bipolar nerve stimulation. The utility and evolution of Checkpoint intraoperative nerve stimulation is best demonstrated in the author’s personal evolution in performing the double fascicular nerve transfer for restoration of elbow flexion. By providing options for precise fascicular identification, as well as options for global nerve stimulation and evaluation, a reliable and exact reconstruction can be provided to the patient. Multiple cases of upper trunk level brachial plexus injury will be presented, each of whose reconstruction includes spinal accessory to suprascapular nerve transfer, radial to axillary nerve transfer, and the double fascicular nerve transfer. Focus will be provided to the double fascicular nerve transfers.
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Please note: Case reports and white papers are company funded and not peer reviewed.
