Evaluation of Triple Neurotization Technique as a Single Procedure in Adult Traumatic Brachial Plexus Injury

Abstract

Introduction: Brachial plexus injuries are common and result in significant disabilities. This study evaluated the outcome of triple neurotization as a single procedure for upper trunk brachial plexus injury. Patients and Methods: Some 25 adult consecutive patients with injured upper trunk brachial plexus who underwent microscopic reconstructive surgery using triple neurotization technique in the authors' institute were recruited in this study. Data on operative and functional outcomes were captured. Modified Narkas scale was used to evaluate the shoulder function in addition to Waikakul scale which was used to evaluate the elbow function. Data were analyzed with respect to short and long term with a median follow-up duration of two years. Results: Assessment of the recovered shoulder abduction was excellent in 48% (n=12), good in 24% (n=6), fair in 16% (n=4), and poor in 12% of cases (n=3). Shoulder external rotation recovery was excellent in 48% (n=12), good in 12% (n=3), fair in 12% (n=3), and poor in 28% of cases (n=7). Recovery of elbow flexion was excellent in 60% (n=15), good in 12% (n=3), fair in 12% (n=3), and poor in 16% of cases (n=4). The mean value of recovered shoulder abduction was 111.26 degrees (range: 70-150). The mean value of restored shoulder external rotation was 57.5 degrees (range: 45-70). The mean value of restored elbow flexion was 75 degrees (range: 55-120). Conclusion: Triple neurotization technique can be effective to restore elbow flexion, shoulder abduction, and external rotation in adult patients with upper trunk brachial plexus injury.

The Outcome of Single Versus Double Nerve Transfers in Shoulder Reconstruction of Upper and Extended Upper-Type Brachial Plexus Injuries

“…In studies that investigated DNT procedures, the mean recovery of ≥M4 shoulder abduction ranged from 30% to 88.9%, 10 , 13 , 14 , 15 , 18 and the mean ROM ranged from 92º to 115º. 11 , 12 , 13 , 14 , 15 , 16 , 17 The mean recovery of ≥M4 external rotation ranged from 20% to 60%, with a mean ROM ranging from 54º to 136º. 11 , 12 , 13 , 14 , 15 , 16 , 17 In this case series, the results of the DNT for shoulder abduction were similar to published literature, reaching a mean of 99º with 69% of patients experiencing recovery ≥M4 and a mean of 69º of external rotation with 52% of patients having ≥M4 recovery.…”

“…Several authors have reported increased shoulder function after double nerve transfer (DNT) with the intercostal nerve 12 and median or ulnar nerve 13 as nerve donors and the axillary nerve as the target nerve. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Cardenas et al 19 in their study in 2008 reported that the more nerves transferred, the higher the abduction range in restoring shoulder function. Similar studies comparing SNT with DNT reported a greater shoulder range of motion (ROM) or a higher recovery rate of ≥M4 for shoulder function with DNT.…”

Systematic Review With Meta-Analysis: Are Muscle Transfers a Satisfactory Treatment Option to Restore Shoulder Abduction in Delayed Adult Brachial Plexus Injuries?

“…The time interval between the injury and the surgical intervention is one of the main factors that guide the therapeutic algorithm [5,15]. The best functional outcomes can be achieved via primary nerve reconstruction comprising direct nerve repair, neurolysis for scar compression, nerve grafting, and nerve transfers performed no later than six months following injury [16][17].…”

“…The best functional outcomes can be achieved via primary nerve reconstruction comprising direct nerve repair, neurolysis for scar compression, nerve grafting, and nerve transfers performed no later than six months following injury [16][17]. As a result of interruption of the motor innervation, a time-dependent irreversible degeneration commences at the motor endplate [5,15]. Reinnervation procedures performed 18-24 months following injury usually result in a functionless muscle [18][19].…”