Nerve Transfers for Reconstruction of Traumatic Brachial Plexus Injury

Abstract

Introduction: Neurolysis, nerve repair, or nerve grafting are options which are used for treatment of adult traumatic brachial plexus palsy. Because of the frequency of avulsion-type injuries, the lack of available nerve roots for grafting, and the extensive scarring at the injury site, these treatment options are frequently inadequate to restore function in the severely affected patient.In this situation nerve transfer is choice. Nerve transfer (neurotization) means redirection of an intact motor nerve from one muscle to the distal undamaged portion of a nerve. Aim: The purpose of this study was to assess the outcomes of different nerve transfers techniques in the restoration of shoulder and elbow functions in patients with brachial plexus injuries. Material and Methods: Between 2010-2013 a total of 16 patients with brachial plexus lesions underwent surgical exploration and reconstruction of the brachial plexus included transfer of the distal spinal accessory nerve into the suprascapular nerve for shoulder abduction and nerve transfer of a single motor fascicle from both ulnar and/ or median nerves or intercostal nerves directly to the biceps and brachialis branches of the musculocutaneous nerve for elbow flexion. The average age of patients was 22 years (16 and 40 years). The injury-surgery interval was between 3-4months. The follow-up period ranged from 5 to 20 months (average, 13 months). The clinical examination included testing of motor power in upper extremity muscles using the British Medical Research Council Grading System. Assessment included degree of shoulder abduction and recovery of elbow flexion. Results: Useful functional recovery for shoulder abduction was achieved in 15 patients; 75% had good results. The average shoulder abduction was 50 degrees. Good result for elbow flexion was 25% in intercostals nerves transfer and 57% for ulnar and/or median nerve transfer .No motor or sensory deficits related to the ulnar or median nerves were noted and all patients maintained good hand function. Conclusion: Nerve transfer techniques to restore shoulder and elbow function has good result for treatment of traumatic brachial plexus injury.it seems that use of ulnar or median nerve for transfer has much better result than intercostal nerve.