United Brachial Plexus Network, Inc.

The intercostal nerves are nerves that go to or through the muscles between each rib. Most primary surgeries use the sural nerve from the back of the leg. In Michaela's case she had so much damage, scar tissue on C-5 and C-6 and avulsions of C-8, T-1 and T-2 and the worst of it lower in the plexus, that the doctor here thought it was wiser to go ahead and use those nerves for her primary surgery instead of the sural nerve from the leg. Then if more nerve grafting needed to be done in the future the sural nerve would be there. Michaela had intercostal nerves T-3,T-5 and t-6 grafted into the ulnar nerve in the plexus and T-4 which was thicker and longer grafted into the median nerve in the plexus.

I hope I explained this sufficiently. If they had just used the sural nerve to begin with there would not be enough to graft for all the damage done.If you have more ????'s , just ask! I'll explain the best I can. Francine might be able to add more.

For children with very limited or non existent hand function the gracillus muscle transfer is the newest thing. It promises grip and the ability to lift 45 pounds, or for everyday living to be able to drink from a glass or pick up a gallon of milk.

The gracillus muscle is located in the inner thigh. It is used to draw the knees together, but removing it does not take away the ability to draw the knees together. It is usually the first muscle harvested for transplants. It is removed from the inner thigh through a small incision at the knee and transplanted in the inner lower arm and then eventually covered with skin grafts and requires a few followup plastic surgeries.There are risks that the graft won't take, it is psychologically hard on the child to see an open wound for 5 days and it is very invasive. It is not something to take lightly. That is why as long as Michaela is gaining function, I'm procrastinating!

http://www.injurednewborn.com/jocey/jocey.html

this is the gracilis transfer surgery page for jocey...

For NancyP,
You mentioned meeting with Dr. Klebuc last April but that you're waiting to see if you need intercostal grafts before the gracilis. I thought the gracilis transfer was something that came much later than any kind of nerve grafting, which I understand is usually done before age 1. My son is 7. I'm confused! Please help....
jaime

Jaime,

They are looking to see if Kelsey has enough electricity to keep the gracilis muscle "alive" after transplanting it. If she doesn't, they will do the intercostal graft. Kelsey did have primary surgery at 14 months and they used the sural nerve. Dr. Nath has talked about doing an intercostal graft for her for about 2 years. I notice on some of the adult posts (especially TBPI) that they use the intercostal grafting to help them regain function. We are hoping to put off the Gracilis transfer a while longer as we don't think Kelsey is mature enough to handle it just yet. She turned 6 in November.

Nancy

Michaela turned 6 in October and we feel the same way. How does a 6, 7, or 8 year old deal with this? How do you explain to them the scarring left behind especially for girls to have all the scarring from the skin grafts taken from the groin area.How do you leave their self esteem intact? That's why I feel a psychologist is needed in every one of these cases.

Nancy,
Thanks, I think I understand...there would be no point in transplanting a muscle if there's no nerve supply...I guess I should just wait and see what Dr. Klebuc says at our consult, but it does help me to learn a little here and then hopefully I can come up with some intelligent questions.
I worry too about self-esteem issues with this surgery. I don't think it matters if these kids are boys or girls as far as that goes. Gosh, will gaining function be worth this? I'd love to hear from parents whose children have had this done!!!
Another thought - I wonder if anyone else feels the same way....I want to get these surgeries done and out of the way! I hate to keep interupting my son's life for surgery and recovery. He's 10 weeks post caps and just now starting to act like his normal self. I don't want to do this to him over and over. Usually I don't worry about these things, but today I am!!

Jaime,

I know exactly what you mean. Kelsey has had 4 surgeries, 3 in the last 2 years. She has several to go, and I want them all to be done! I think you will like Dr. Klebuc. He is a very understanding man and really took the time to talk with me and EXPLAIN things to me. He listened to my concerns, and validated what I said. He met with me at 8 at night in the hospital room. I was amazed at him. He is also very honest about what this can and can't do for your child, and doesn't want to do the surgery until a child is at least 6. Please share what he tells you, as it will help all of us contemplating this procedure for our children.

Nancy

Nancy, I'm glad to hear Dr. Klebuc is easy to talk with. That always helps. We were supposed to meet with him during our last surgery there in December, but our plane was leaving and it just didn't work out. I have a couple more questions...Is an intercostal nerve transfer done at the same time as the gracilis? Or is that something done prior? Also, I think LeAnn mentioned this gracilis transfer is supposed to give the child a grip and the ability to hold 45 lbs? That seems amazing to me (the 45 lbs part). Did Dr. Klebuc give that same information to you? What exactly did he say it would do for your child? Would you mind telling me how much hand function your child has? My son has about a 1 lb pinch, and limited extension of his fingers. The pinky has very little flexion and the thumb can't extend. I have two fears - 1. that he'll say he has too much function in his hand to do the surgery (I'm not sure what the requirements are for this surgery) and 2. that yes, he can do the surgery and when do we want to do it. Those are my fears!

Jaime, I got my information from Dr. Nath at Michaela's last eval. I have not met Dr. Klebuc yet, but hope to in the near furture to see if he gives us the same info and opinions. I totally trust Dr. Nath though.