Nerve Grafting vs. Common Infraclavicular Intraplexal Nerve Transfer in Elbow Flexion Restoration.

AIM The aim of this study is to compare the results of nerve grafting vs. common infraclavicular intraplexal nerve transfer in elbow flexion restoration. MATERIAL AND METHODS The study included 39 patients with upper brachial plexus palsy who were operated using common intraplexal nerve transfer (Oberlin procedure) and the thoracodorsal and medial pectoral nerve transfer to the musculocutaneous nerve or grafting of C5 to the musculocutneous nerve, for elbow flexion restoration. All patients underwent detailed preoperative evaluation, which included clinical and neurological examination, electrophysiological investigation and neuroradiological studies. The final evaluation of achieved recovery of elbow flexion was done two years after surgery, using the British Medical Council scale. RESULTS We achieved functional satisfactory recovery (M3, M4, M5) in 29 of 30 patients (96.7%) in the common intraplexal nerve transfer group, and in 4 of 9 patients in the nerve grafting group (44.4.%). There was a significant statistical difference between these two groups in favor of common intraplexal nerve transfers over C5 grafting to the musculocutaneous nerve regarding functional recovery. CONCLUSION The results of our study concur with the findings of previous studies favoring intraplexal nerve transfers over nerve grafting in the restoration of elbow flexion in upper brachial plexus palsy. They reveal that intraplexal nerve transfers are clearly the primary treatment modality in cases of upper brachial plexus palsy without any sign of viable proximal C5 stump presence, while in cases of upper brachial plexus palsy with signs of viable proximal C5 stump the choice of the best treatment modality is still controversial.

[1]  P. Deb,et al.  Management of Isolated Musculocutaneous Injury: Comparing Double Fascicular Nerve Transfer With Conventional Nerve Grafting. , 2015, The Journal of hand surgery.

[2]  S. Wolfe,et al.  Optimal Axon Counts for Brachial Plexus Nerve Transfers to Restore Elbow Flexion , 2015, Plastic and reconstructive surgery.

[3]  R. Mattar,et al.  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 , 2014, Microsurgery.

[4]  R. Gasparotti,et al.  Brachial Plexus Injuries in Adults: Management and Repair Strategies in our Experience. Results from the Analysis of 428 Supraclavicular Palsies , 2013 .

[5]  R. Spinner,et al.  Double fascicular nerve transfer for elbow flexion: is 2 better than 1? , 2013, Neurosurgery.

[6]  M. Socolovsky,et al.  Efficacy and safety of Oberlin's procedure in the treatment of brachial plexus birth palsy. , 2012, Neurosurgery.

[7]  M. Socolovsky,et al.  Upper Brachial Plexus Injuries: Grafts vs Ulnar Fascicle Transfer to Restore Biceps Muscle Function , 2012, Neurosurgery.

[8]  D. Grujičić,et al.  Nerve transfers using collateral branches of the brachial plexus as donors in patients with upper palsy—thirty years’ experience , 2011, Acta Neurochirurgica.

[9]  L. Flores.  Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome. , 2011, Arquivos de neuro-psiquiatria.

[10]  S. Wolfe,et al.  Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis. , 2011, The Journal of bone and joint surgery. American volume.

[11]  R. Tubbs,et al.  Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. , 2009, Journal of neurosurgery. Pediatrics.

[12]  R. Midha,et al.  Nerve transfers for severe nerve injury. , 2009, Neurosurgery clinics of North America.

[13]  P. Soucacos,et al.  Restoration of shoulder function with nerve transfers in traumatic brachial plexus palsy patients , 2006, Microsurgery.

[14]  S. Mackinnon,et al.  Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. , 2005, The Journal of hand surgery.

[15]  D. Grujičić,et al.  The use of thoracodorsal nerve transfer in restoration of irreparable C5 and C6 spinal nerve lesions. , 2005, British journal of plastic surgery.

[16]  R. Tiel,et al.  Direct plexus repair by grafts supplemented by nerve transfers. , 2005, Hand clinics.

[17]  S. Amr,et al.  Repair of brachial plexus lesions by end‐to‐side side‐to‐side grafting neurorrhaphy: Experience based on 11 cases , 2005, Microsurgery.

[18]  C. Oberlin,et al.  Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy. , 2004, The Journal of bone and joint surgery. American volume.

[19]  D. Garozzo,et al.  Reinnervation of the biceps in C5-7 brachial plexus avulsion injuries: results after distal bypass surgery. , 2004, Neurosurgical focus.

[20]  A. Narakas.  The treatment of brachial plexus injuries , 2004, International Orthopaedics.

[21]  J. Terzis.  Obstetrical Brachial Plexus Paralysis, Part 1 , 2004 .

[22]  S. Mackinnon,et al.  Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries. , 2004, Journal of neurosurgery.

[23]  V. Kawinwonggowit,et al.  One‐fascicle median nerve transfer to biceps muscle in C5 and C6 root avulsions of brachial plexus injury , 2003, Microsurgery.

[24]  S. Mackinnon,et al.  Patient outcome following a thoracodorsal to musculocutaneous nerve transfer for reconstruction of elbow flexion. , 2002, British journal of plastic surgery.

[25]  D. Grujičić,et al.  Transfer of the Medial Pectoral Nerve: Myth or Reality? , 2002, Neurosurgery.

[26]  R. Tubbs,et al.  Surgical Relationship of the Medial Pectoral Nerve to the Musculocutaneous Nerve: A Cadaveric Study , 2001, Neurosurgery.

[27]  O. Aszmann,et al.  The anatomy of the pectoral nerves and their significance in brachial plexus reconstruction. , 2000, The Journal of hand surgery.

[28]  V. Kawinwonggowit,et al.  Transfer of a Single Fascicle from the Ulnar Nerve to the Biceps Muscle after Avulsions of Upper Roots of the Brachial Plexus , 2000, Journal of hand surgery.

[29]  S. Mackinnon,et al.  Nerve transfers in the upper extremity. , 2000, Hand clinics.

[30]  D. Grujičić,et al.  Results of nerve transfers to the musculocutaneous and axillary nerves. , 2000, Neurosurgery.

[31]  A. Narakas,et al.  Brachial Plexus Lesions , 1999, Springer Berlin Heidelberg.

[32]  L. Sedel,et al.  Complete traumatic brachial plexus palsy. Treatment and outcome after repair. , 1999, The Journal of bone and joint surgery. American volume.

[33]  S. Leechavengvongs,et al.  Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases. , 1998, The Journal of hand surgery.

[34]  P. Richardson.  Recovery of biceps function after delayed repair for brachial plexus injury. , 1997, The Journal of trauma.

[35]  C. Oberlin,et al.  Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. , 1994, The Journal of hand surgery.

[36]  M. Samardžić,et al.  Donor nerves in the reinnervation of brachial plexus. , 1986, Neurological research.