Anatomical variations of intercostobrachial nerve: A potential candidate for neurotization after traumatic median nerve injury?

BACKGROUND: This study focused on the anatomical characteristics and variations of intercostobrachial (ICBN) nerve and median nerve to investigate the possible use of ICBN in restoration of sensory damage of hand after traumatic median nerve injury and to evaluate the feasibility of ICBN neurotization to median nerve.
METHODS: Variations of ICBN were noted in 16 axillary region dissections of eight cadavers. Measurements for ICBN’s suitability in terms of neurotization to brachial plexus were done with millimetric devices. The distance of ICBN to the distal end of the lateral (LCMN) and medial (MCMN) contributions of the median nerve and the diameters of ICBN, LCMN, and MCMN were measured.
RESULTS: Fifteen axillary dissections exhibited ICBN, whereas it was absent on the left side of one of the cadavers. The mean diameter of ICBN at its origin was 2.0±0.7 mm and the mean diameter of ICBN at its coaptation point was 3.1±0.9 mm. The mean diameter of the LCMN was 3.9±2.0 mm, the mean diameter of MCMN was 3.5±0.9 mm. The length of ICBN was found to be adequate at both 45 and 90° of shoulder abduction to be extended to both LCMN and MCMN. The diameters of LCMN and MCMN were not significantly correlated with the diameter of ICBN both at origin and at coaptation point (LCMN: p=0.55–0.63 and MCMN: p=0.89–0.85). There is no significant difference between the diameter of LCMN and the diameter of ICBN at its coaptation point (p=0.168) and also between the diameter of MCMN and the diameter of ICBN at its coaptation point (p=0.232).
CONCLUSION: All ICBNs dissected showed adequate length to reach the lateral and medial contribution of the median nerve directly. The ICBN could be a feasible candidate since its diameter was close to LCMN and MCMN according to the descriptive and inferential statistics.

Ýnterkostobrakiyal sinirin anatomik varyasyonlarý: Travmatik median sinir yaralanmasýndan sonra potansiyel bir nörotizasyon adayý olabilir mi?

AMAÇ: Bu çalýþma, travmatik median sinir yaralanmasýndan sonra eldeki duyusal hasarýn restorasyonunda ICBN’nin olasý kullanýmýný araþtýrmayý amaçlamýþtýr. ICBN nörotizasyonunun median sinire uygulanabilirliðini deðerlendirmek için interkostobrakiyal (ICBN) sinir ve median sinirin anatomik özellikleri ve varyasyonlarý incelenmiþtir.
GEREÇ VE YÖNTEM: Sekiz kadavranýn 16 üst ekstremitesinde aksiller bölge diseksiyonu yapýldý. ICBN varyasyonlarý kaydedildi. ICBN’nin brakiyal pleksusa nörotizasyon açýsýndan uygunluðunun ölçümleri milimetrik cihazlarla yapýldý. ICBN’nin median sinirin lateral (LCMN) ve medial (MCMN) katkýlarýnýn distal ucuna olan mesafesi ve ICBN, LCMN ve MCMN çaplarý ölçüldü.
BULGULAR: On beþ aksiller diseksiyonda ICBN mevcutken kadavralardan birinin sol tarafýnda mevcut deðildi. ICBN’nin baþlangýç noktasýndaki ortalama çapý 2.0±0.7 mm ve koaptasyon noktasýndaki ortalama ICBN çapý 3.1±0.9 mm idi. LCMN’nin ortalama çapý 3.9±2.0 mm, MCMN’nin ortalama çapý 3.5±0.9 mm idi. ICBN’nin hem 45 hem de 90 derece omuz abdüksiyonunda, LCMN ve MCMN’ye uzanabilecek þekilde yeterli uzunluða sahip olduðu bulundu. LCMN ve MCMN çaplarý, hem orijin hem de koaptasyon noktasýnda ICBN’nin çapý ile anlamlý derecede iliþkili deðildi (LCMN: p=0.55–0.63 ve MCMN: p=0.89–0.85). LCMN çapý ile koaptasyon noktasýndaki ICBN çapý arasýnda (p=0.168) ve ayrýca MCMN çapý ile koaptasyon noktasýnda ICBN çapý arasýnda (p=0.232) anlamlý bir fark saptanmadý.
TARTIÞMA: Disseke edilen tüm ICBN’ler, median sinirin lateral ve medial katkýsýna doðrudan ulaþmak için yeterli uzunluk gösterdi. Tanýmlayýcý ve çýkarýmsal istatistiklere göre ICBN çapý LCMN ve MCMN’ye yakýn bulundu. Bu nedenlerIe ICBN, travmatik yaralanmalar sonrasý median sinir nörotizasyonu için uygun bir aday olabilir.