Transposition of functioning muscles in complex treatment of adult patients with injuries of the bracheric plexus (literature review)

Abstract

Introduction. Injuries to the brachial plexus are one of the most severe types of injuries to the nerves of the upper limb, and variants with the separation of the roots from the spinal cord represent a very difficult category of injuries to treat. Among patients who have received such injuries, there is a very high incidence of disability, since it is possible to achieve only partial restoration of the function of the upper limb. Recently, the method of transposition of functioning muscles has been growing in popularity due to its reliability and relatively short recovery time of function.The purpose of the work is to analyze the literature data on the possibility of using the method of transposition of functioning muscles in the complex treatment of victims with brachial plexus injuries.The authors have searched PubMed and RSCI databases over the past 25 years for keywords: peripheral nerve damage, tendon transposition, transposition of functioning muscles, nerve injury, brachial plexus injury, spinal cord root avulsion. In the selected 23 most relevant papers, the muscles used for transposition, indications and timing of operations, results and complications were analyzed, compared with other methods of surgical treatment of brachial plexus injuries. The analysis of studies has shown that the transposition of functioning muscles allows in most cases to restore the target movement to the useful level of M3–M4 on the MRC scale, is a more reliable method and allows achieving better results, especially in patients with severe complete injuries of the brachial plexus. An important disadvantage of free hip thin muscle transplantation operations is the risk of microanastomosis thrombosis, which requires detailed preoperative planning and good microsurgical technique of the operating team.Conclusion. Free transplantation of 2 functioning muscles is currently the method of choice for restoring upper limb movements in patients with complete brachial plexus injuries.