Dennervated SBRN versus Sural Nerve Grafting: A Case-control Analysis of 75 Patients: Level 3 Evidence

Abstract

Salary: Mayo Clinic (Shin)Royalty: Trimed (Shin)Contracted Research: Bacterin International (Shin)Other (Please describe): editor Techniques Hand Upper Extremity (Shin) The purpose of our study was to perform a case-control analysis of two sources of nerve graft; the denervated superficial branch of the radial nerve (SBRN) in patients with ipsilateral brachial plexus injuries and the normal sural nerve in nerve grafting to restore function in the upper extremity. Over a 10-year period, 25 patients underwent SBRN nerve grafting with a dennervated ipsilateral nerve for brachial plexus injuries, which were T matched 2:1 with 50 patients who underwent sural nerve grafting by age, gender, and BMI (Comparisons are summarized in Table 1). The average follow-up for the use of ipsilateral dennervated SBRN patients was 2.5 years (1-7) and for the sural patients was 2.8 years (1-9). In the dennervated SBRN group, only 3 (12%) of patients experienced grade III or higher muscle function. All 3 of these patients underwent a grafting of the spinal accessory to triceps motor branch. This is in contrast to 20 (36%) of the patients who underwent sural nerve grafting achieving grade III or higher muscle recovery (P < 0.01), including C5, C6, or upper trunk to axillary (n=5) and musculocutaneous (n=7); or spinal accessory to axillary (n=1), musculocutaneous (n=2), and triceps motor branch (n=5). Only 12% of the dennervated SBRN group had EMG signs of muscle recovery compared to 61% of the sural nerve group (P < 0.01). Smoking had a negative impact on muscle recovery, decreasing the rate of grade III or higher recovery in the dennervated SBRN group (P < 0.01) and the sural group (P = 0.01). No other factors had an impact on muscle recovery. Overall, patients in both groups had significant improvements in their preoperative to postoperative pain and DASH scores (P < 0.04). •Use of ipsilateral dennervevated SBRN nerve grafts in patietns with brachial plexus injures has significantly poorer outcomes when compared to sural nerve grafts in the treatment of brachial plexus injuries in a matched series.•The use of this deinnervated nerve should be saved for situations when no other nerves grafts are available and should be avoided when sural nerve grafts are available.•Patients also should be counseled on the risks of smoking when choosing to undergo brachial plexus reconstruction.