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Seven years ago, a patient aged 50 suffered from a complete traumatic lesion (rupture and avulsion of spinal roots) of the left brachial plexus resulting in complete arm palsy. For restoration of elbow flexion, the musculocutaneous nerve may be connected to a donor nerve. Classical nerve reconstruction techniques perform end-to-end coaptation of a donor nerve with the receptor nerve, thereby sacrificing the function of the donor nerve. Neurophysiological investigations indicated that cortical reorganisation but no spinal reorganisation occurs with these patients.1 Recently, a new therapeutic option for deafferentiated muscles was suggested, which allows preservation of the donor nerve function: end-to-side coaptation.2 With our patient, a nerve graft was connected to the left phrenic nerve using end-to-side coaptation (and end-to-end coaptation of the nerve graft to the diseased musculocutaneous nerve). The end-to-side coaptation at the phrenic nerve allows …
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