Outcomes of Surgical Treatment of Brachial Plexus Injuries Using Nerve Grafting and Nerve Transfers

Abstract

Between 1993 and 1998, 32 male patients with brachial plexus injuries were surgically treated. Eighteen interfascicular grafting and 71 extraplexal neurotization procedures were performed separately or in combination. Donor nerves were the intercostals, spinal accessory, phrenic, contralateral C7, and cervical plexus, in order of frequency. Patients were followed for a minimum of 24 (average, 35) months. Biceps function was best following grafting the musculocutaneous nerve itself, or neurotization with the phrenic nerve (100 percent grade 4), followed by neurotization with the intercostals (89.5 percent grade 3 or more) and last, grafting the C5 root or upper trunk (grade 3 in one of three patients). Phrenic to suprascapular neurotization produced the best results of shoulder abduction (40 to 90 degrees), followed by combined neurotization of the spinal accessory to suprascapular and phrenic to axillary (20 to 90 degrees). Sensory recovery over the lateral forearm and palm varied from S2 to S3+, according to the method of reconstruction.

Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

“…Subsequently, several authors have reported their experience with intercostal nerve transfer [4,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] . In order to restore maximum function of the arm, as many intercostal nerves as possible are harvested and transferred.…”

Evaluation of suprascapular nerve neurotization after nerve grafting or transfer in the treatment of brachial plexus traction lesions

“…These studies comprise only 75 patients overall. 1,5,7,9,10,21,25 The differing results are shown in Table 5. Results of a metaanalysis 21 indicated that the accessory nerve-suprascapular nerve transfer is an effective repair technique; however, the indications for surgery in the various studies differed, and the results were not analyzed or presented uniformly.…”

“…We do not consider this type of postoperative function a result of the surgical procedure. 10 Second, we reported on a selected group of upper plexus lesions, in which cases involving with a distally located brachial plexus lesion affecting shoulder function were excluded. Recovery after nerve repair is better in the latter group because of the absence of root avulsion and a shorter distance of the lesion to the target muscle.…”

“…14,24 In adults who have undergone brachial plexus reconstruction, good results of shoulder function recovery have been reported. 1,4,7,10,21,22,24,28,34,35 Interpretation of the data presented, however, is difficult for the following reasons. First, the outcome data pertaining to different types and localizations of lesions have been pooled-for instance, superior trunk lesions have been grouped with axillary nerve lesions, and traction lesions with gunshot wounds and sharp wounds.…”

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 1): Transferencias nerviosas extraplexuales

“…Todas ellas mostraron resultados favorables, con aproximadamente un 50% de reinervación del bíceps, y una fuerza M3 o más en la escala BMRC. Más recientemente, otras series han sido publicadas confirmando que esta técnica también es útil en niños con parálisis obstétrica del plexo braquial 13,27,35,49,58,68 . Los axones de cada nervio intercostal se reducen en número en un 10% cada 10 cm de longitud, a medida que van inervando en su recorrido la musculatura inspiratoria accesoria 49 .…”