Neurotization for Elbow Flexion Restoration after Brachial Plexus Injury

Abstract

Background: Restoration of elbow flexion after brachialplexus injury has the first priority in adults. Nerve transfers(neurotization) involves taking nerves with less importantfunctions or branches of a nerve that perform redundantfunctions to restore important function in a more crucial nervethat has been severely damaged. There are many describedneurotization methods for elbow flexion restoration likeOberlin method, Double Fascicular Transfer (DFT) and IntercostalNerves (ICN) transfer. The aim of this study was toevaluate different methods of nerve transfer for restorationof elbow flexion after brachial plexus injury.Patients and Methods: 21traumatic BPI were included inthis study (19 unilateral BPI and 1 bilateral BPI). 4 patientswere operated by Oberlin method, 5 by DFT and 12 by ICNtransfer.Results: 3 primary procedures were used. Oberlin methodin 4 cases (19.0%) 3 cases (75%) give results M3 or more.DFT method in 5 cases (23.8%) all of them give results M3or more. ICN transfer in 12 cases (57.1%) 9 cases (75%) giveresults M3 or more.Conclusion: In upper BPI, DFT is the first option due toeffectiveness without noticeable donor functional affectionand Oberlin method is the 2nd option if median nerve hasfunctional deficit or not well recovered or has been used inanother transfer as in (c5, c6 and c7) cases. Three ICNs transferto musculocutaneous nerve without nerve graft in total BPIis advisable due to effectiveness and least morbidity.