Abstract
Nerve transfers (NT) consist in sectioning a donor nerve and connecting it to the distal stump of a recipient unrepairable nerve. For elbow flexion restoration in brachial plexus palsy (BPP) we used different NT: 1) GF motor Ulnar Nerve to Biceps nerve (Oberlin technique), 2) Double fascicular median/ulnar to biceps/brachialis nerve transfer (Mackinnon), 3) InterCostal Nerves (ICN) to MCN (+/− nerve graft), 4) Medial Pectoral Nerve (MPN) to MCN, 5) ThoracoDorsal Nerve (TDN) to MCN, 6) Spinal Accessory Nerve (SAN) to MCN transfer, 7) Phrenic Nerve (PhN) to MCN, 8) Cervical Plexus C3-C4 to MCN and 9) Contralateral C7 (CC7). I want to present my personal experience using the phrenic nerve (PhN), the intercostal nerves (ICN) and Oberlin’s technique. The aim of this retrospective study is to evaluate the results of this procedure in BPP. NT is an important goal in BPP. ICN transfer into the nerve of biceps for elbow flexion recovery is a reliable procedure in BPP. ICN transfer for triceps offers a positive alternative (Carroll transposition). Oberlin technique is simple and offers better results in a shorter amount of time and is an effective and safe option.
Highlights
A complete functional recovery is the ultimate goal in the treatment of brachial plexus injury
In 1990 – Oberlin proposed the transfer of motor fascicular groups (FG)’s from the ulnar nerve to the biceps branch of the Musculocutaneous nerve (MCN) without an intervening nerve graft; the motor branch from the musculocutaneous nerve to the biceps muscle and the ulnar nerve were found at the midarm level [2]
After performing a 2–3 cm longitudinal epineurotomy in the ulnar nerve, one or two fascicles are found and sutured end to end to the branch of the nerve to the biceps by 3 or 4 stitches of 10–0 nylon. 90% of the patients achieve better than MRC grade 4 elbow flexion with the Oberlin technique [3]
Summary
A complete functional recovery is the ultimate goal in the treatment of brachial plexus injury. In most of our patients, this goal cannot be achieved due to the severity of the injuries and the restriction of donor nerves. The priorities of functional reconstruction in brachial plexus injury have been set as follows [1], in order: 1) elbow flexion; 2) shoulder abduction; 3) wrist and finger flexion and sensation in the median nerve distribution; 4) wrist and finger extension; 5) intrinsic muscle function
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