Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Medial pectoral nerve (MPN) to musculocutaneous nerve (MCN) neurotization for recovery of elbow flexion by biceps reinnervation is a valid option following traumatic injury to the upper brachial plexus. A major criticism of the application of this technique in infants is the smaller size of the MPN and mismatch of viable axons. We describe our institutional experience utilizing this procedure and critically examine functional outcomes.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Office charts and hospital records of children from over an 11-year period beginning January 1997 were reviewed. Of the 53 children of various ages undergoing brachial plexus exploration for traumatic injury of any nature, 20 underwent MPN to MCN neurotization as a part of an overall procedure in the first year of life to treat birth-related brachial plexus palsy and had at least 9 months' follow-up. Medial pectoral nerve to MCN neurotization was chosen if the results of clinical examination and intraoperative electrophysiological evidence were consistent with medial cord function. Functional recovery was defined as the ability of the child to bring their hand to their mouth.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Sixteen patients (80%) gained functional recovery. The median age at surgery was 7 months. Median time to first clinic visit documenting recovery was 11.5 months and median overall follow up was 21.5 months. Preoperative hand function was a useful predictor of recovery of elbow flexion.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Medial pectoral nerve to MCN neurotization is a valid surgical option for the reinnervation of the biceps muscle for birth-related brachial plexus palsy when the hand is functional preoperatively. Useful elbow flexion can be expected in the majority of these children.</jats:p></jats:sec>

Current Concepts in the Management of Brachial Plexus Birth Palsy

“…33 Transfer of the medial pectoral nerve to musculocutaneous nerve has also been described in children with birth palsies, with 70% to 80% of patients gaining functional recovery. 41 With the presence of an intact ipsilateral C7 nerve root, transfer of the C7 nerve root to reinnervate isolated upper trunk lesions has been used with success. 42 In addition, the contralateral C7 root has been used in extensive avulsion injuries in an attempt to regain either elbow flexion or hand function, 42 although persistent synchronicity of movement with the unaffected side has been reported.…”

Results of nerve reconstructions in treatment of obstetrical brachial plexus injuries

“…Reanimation of the shoulder and elbow can also be performed with other nerve transfers, especially if the child is presented late. The use of pectoral nerve to musculocutaneous nerve neurotization has been described with good results [4,34]. The transfer of triceps motor branches of the radial nerve to the axillary nerve appears to be safe and effective.…”

Medial pectoral nerve transfer

“…Wellons and his colleagues 6 report convincing evidence that medial pectoral nerve (MCN) to musculocutaneous nerve (MCN) transfer can improve elbow flexion in infants with birth brachial plexus injury. 6 They performed the MPN transfer procedure in a relatively large number of patients and achieved excellent surgical outcomes.…”

“…Wellons and his colleagues 6 report convincing evidence that medial pectoral nerve (MCN) to musculocutaneous nerve (MCN) transfer can improve elbow flexion in infants with birth brachial plexus injury. 6 They performed the MPN transfer procedure in a relatively large number of patients and achieved excellent surgical outcomes. Their results corroborate those previously reported by Blaauw and Sloof 4 and make a strong case for MPN as a donor nerve that can be used in brachial plexus reconstruction for birth injury.…”