A Comparison of Intercostal and Partial Ulnar Nerve Transfers in Restoring Elbow Flexion Following Upper Brachial Plexus Injury (C5-C6±C7)

Results of 24 nerve repairs at more than one year post-injury

“…In a series of 15 patients, Chammas gave an 8 months delay and a 15-20 months denervation time as a maximum for good recovery (70%) of biceps function after intercostals to musculocutaneous nerve transfer, and used a free gracilis neurotized by intercostals to restore elbow function ulterior to this delay [3].…”

“…The maximum delay determines the cut-off between nerve surgery and muscle transfer. It has also been claimed that the later the repair the worse the results [3]. Following a brachial plexus conference, a consensus that late repairs necessarily give bad results has been reached [4].…”

Median nerve fascicle transfer versus ULNAR nerve fascicle transfer to the biceps motor branch in C5‐C6 and C5‐C7 brachial plexus injuries: Nonrandomized prospective study of 23 consecutive patients

“…In 2003, Sungpet et al described the same type of nerve transfer to the biceps using the median nerve instead of the ulnar nerve as a donor, in patients with upper brachial plexus lesions . Few years later, Nath, Lyons, and Bietz reported their experience on 40 consecutive cases of median nerve fascicle transfer to the biceps in C5‐C6 injuries . The percentage of biceps recovery was similar to the original Oberlin procedure and there were no permanent median nerve deficits.…”

Full‐length phrenic nerve transfer as the treatment for brachial plexus avulsion injury to restore wrist and finger extension

“…In the treatment of total root avulsion of the brachial plexus, although finger flexion can be restored, restoration of wrist and finger extension would be beneficial to regain the flexible movement of an injured hand. The conventional method for restoring wrist and finger extension involves transferring the intercostal nerves to the radial nerve; however, the results are not completely satisfactory6, 7 for the following reasons: (1) the limited number of axons in the intercostal nerves is insufficient to effectively reconstruct wrist and finger function; and (2) identification of the topographic location of the deep branch of the radial nerve, which innervates the extensor digitorum, extensor carpi radialis, and extensor carpi ulnaris of the wrist in the main trunk of the radial nerve at the upper arm level, is difficult. Phrenic nerve transfer, first described by Gu and colleagues,9 has been widely performed because it is efficient and does not significantly affect the patient's pulmonary function 11–13…”

“…In patients with complete brachial plexus avulsion, intercostal nerves are often transferred to the radial nerve to restore wrist and finger extension. However, the results of this technique have not been satisfactory 6, 7. Yan et al8 reported that the medial fascicle of the radial nerve at the level of the latissimus dorsi insertion continues to form the deep branch of the radial nerve, which innervates the extensor digitorum, extensor carpi radialis, and the extensor carpi ulnaris of the wrist.…”