Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

Abstract

Background: Distal nerve transfers are an innovative modality for the treatment of C8-T1 brachial plexus lesions. The purpose of this case series is to report the authors’ results with hand restoration function by nerve transfer in patients with lower brachial plexus injury. Methods: Three consecutive nerve transfers were performed in a series of 11 patients to restore hand function after injury to the lower brachial plexus: brachialis motor branch to anterior interosseous nerve (AIN) and supinator branch to the posterior interosseous nerve (PIN) in a first surgical procedure, and AIN to pronator quadratus branch of ulnar nerve between 4 and 6 months later. Results: In all, 11 male patients underwent 33 surgical procedures. Time between brachial plexus injury and surgery was a mean of 11 months (range 4–13 months). Postoperative follow-up ranged from 12 to 24 months. We observed recovery of M3 or better finger flexion strength (AIN) and wrist extension (PIN) in 8 of the 11 surgically treated upper limbs. These patients recovered full thumb and finger extension between 6 and 12 months of surgery, without significant loss of donor function. Conclusion: Nerve transfers represent a way of restoring volitional control of upper extremity function in patients with C8-T1 brachial plexus injury.

Distal median and radial nerve branch transfer techniques for upper extremity reanimation

“…Fifteen months postoperatively, the patient regained MRC grade 3 strength of the FPL and FDP [20] . In a case series of 4 patients written by Ray et al, all patients with brachial plexus injuries who received brachialis to AIN transfers regained grip strength, and 3/4 regained at least partial pinch strength [21] . All patients met at least MRC grade 3, with 3/4 patients recovering MRC grade 4 function of the FPL and FDP [21] .…”

“…In a case series of 4 patients written by Ray et al, all patients with brachial plexus injuries who received brachialis to AIN transfers regained grip strength, and 3/4 regained at least partial pinch strength [21] . All patients met at least MRC grade 3, with 3/4 patients recovering MRC grade 4 function of the FPL and FDP [21] . Hawasli et al reported a detailed case of a patient who received a brachialis to AIN transfer after a complete C7 spinal cord injury [18] .…”

Lesiones del plexo braquial en adultos: Una revisión narrativa de la literatura

“…Esto puede hacerse con transferencias nerviosas o tendinosas. Estudios recientes 35,36 han demostrado buenos resultados de las transferencias nerviosas de ramas del braquial para los nervios interóseo anterior y pronador redondo, o del supinador para el nervio interóseo posterior en caso de ser necesario. 3) Lesión global del plexo preganglionar: son las lesiones traumáticas del plexo, de peor pronóstico.…”

“…The treatment aims to restore a functional grip and fist either with nerve or tendon transfers. Recent studies 35 36 have shown good outcomes after transfers of the branch to the brachialis (musculocutaneous nerve) to the anterior interosseous nerve and pronator teres branch or from the supinator to the posterior interosseous nerve if necessary.…”