Deficits dans le territoire de nerfs moteurs donneurs dans une série de neurotisations pour la réanimation de paralysies nerveuses périphériques chez 29 patients

Abstract

Distal nerves transfers give good results on the reanimation of a motor deficit, and are therefore a golf standard technique for peripheral nerve palsy management. However, there is a risk of motor deficit in the territory of the harvested nerve, which is poorly reported in the literature. We report our cases of motor deficits, in a series of 29 patients. We evaluated the motor function of the nerves harvested for neurotizations before and after surgery using the BMC grading system. We followed the recovery in cases of postoperative deficits. Between November 2015 and December 2016, we performed neurotizations on 29 patients for peripheral nerve palsies. We performed the following nerve transfers: Oberlin procedure for elbow flexion in 13 cases. From the spinal accessory nerve (XI) to triceps in one case, 10 XI and three C7 root fascicles to the suprascapular nerve. Triceps long head to axilary nerve in 17 cases, ulnar nerve fascicle to teres minor in three cases. We performed a total of 66 nerve transfers. There was a motor deficit in four patients. The surgeon's learning curve, the level of nerve harvesting, and the intraneural anatomy may explain those deficits. A rate of 13 % of motor deficit in the territory of harvested nerves for nerve transfers can be expected after such a procedure. It recovered completely in 50 % of our cases.