Partial Brachial Plexus Injuries Research Articles

Triceps-to-Biceps Tendon Transfer Technique for Restoration of Elbow Flexion in Adult Brachial Plexus Injury.

Restoration of elbow flexion is a priority in treating adult traumatic brachial plexus injuries. A tendon transfer is an ideal option for patients not candidates for reconstructive nerve surgery or free-functioning muscle transfer. For patients with a partial brachial plexus injury or a pan plexus injury with adequate recovered triceps function and loss of elbow flexion, a triceps-to-biceps tendon transfer is a nonmicrosurgical option to restore elbow flexion. The technique of triceps-to-biceps transfer in which the complete triceps tendon is transferred laterally, secured lateral to the radial tuberosity, and reinforced with suture to the biceps tendon is described.

Adult traumatic brachial plexus injuries: advances and current updates.

Nerve grafting, tendon transfer and joint fusion are routinely used to improve the upper limb function in patients with brachial plexus palsies. Newer techniques have been developed that provide additional options for reconstruction. Nerve transfer is a tool for restoring upper limb function in total root avulsions where nerve grafting is not possible. In partial brachial plexus injuries, nerve transfers can greatly improve shoulder, elbow, wrist and hand function. Intraoperative electrical stimulation can be used to diagnose precisely which nerve is injured and to choose which nerve fascicles should be transferred. Finally, measuring the postoperative outcome can improve the evaluation of our techniques. The aim of this article was to present the current techniques used to treat patients with brachial plexus injury.

The Effectiveness of Different Nerve Transfers in the Restoration of Elbow Flexion in Adults Following Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Restoration of elbow flexion is an important goal in the treatment of patients with traumatic brachial plexus injury. Numerous studies have described various nerve transfers for neurotization of the musculocutaneous nerve (or its motor branches); however, there is uncertainty over the effectiveness of each method. The aim of this study was to summarize the published evidence in adults with traumatic brachial plexus injury. Medline, Embase, medRxiv, and bioRxiv were systematically searched from inception to April 12, 2021. We included studies that reported the outcomes of nerve transfers for the restoration of elbow flexion in adults. The primary outcome was elbow flexion of grade 4 (M4) or higher on the British Medical Research Council scale. Data were pooled using random-effects meta-analyses, and heterogeneity was explored using metaregression. Confidence intervals (CIs) were generated to the 95% level. We included 64 articles, which described 13 different nerve transfers. There were 1,335 adults, of whom 813 (61%) had partial and 522 (39%) had pan-plexus injuries. Overall, 75% of the patients with partial brachial plexus injuries achieved ≥M4 (CI, 69%-80%), and the choice of donor nerve was associated with clinically meaningful differences in the outcome. Of the patients with pan-plexus injuries, 45% achieved ≥M4 (CI, 31%-60%), and overall, each month delay fromthe time of injury to reconstruction reduced the probability of achieving ≥M4 by 7% (CI, 1%-12%). The choice of donor nerve affects the chance of attaining a British Medical Research Council score of ≥4 in upper-trunk reconstruction. For patients with pan-plexus injuries, delay in neurotization may be detrimental to motor outcomes. Therapeutic IV.

984 The Efficacy of Different Nerve Transfers to Restore Elbow Flexion in Adults Following Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Abstract Aim There are numerous donors available for neurotisation of the musculocutaneous nerve, following traumatic brachial plexus injury (BPI). However, there is uncertainty over which method is most effective for restoring elbow flexion. We set out to summarise and compared different nerve transfers for restoring elbow flexion after traumatic BPI in adults. Method Medline, Embase, medRxiv and bioRxiv were systematically searched from inception to 12 th April 2021. Studies reporting outcomes of nerve transfers to restore elbow flexion in adults were included. BPIs were categorised as partial or pan plexus. The primary outcome was ≥M4 elbow flexion on the British Medical Research Council (BMRC) scale. Results We included 64 articles, describing 13 different nerve transfers. There were 1335 adults with 813 (61%) partial and 522 (39%) pan plexus injuries. 75% of patients with partial BPIs achieved ≥M4 (95% CI 69%-80%); double Oberlin or two intercostal nerves appeared to give recovery. For patients with pan plexus injuries, 45% achieved ≥M4 (95% CI 31%-60%) and each month delay from injury to reconstruction reduced the probability of achieving ≥M4 by 7% (95% CI 1%-12%) where intercostal, phrenic or spinal accessory nerves were used as donors. Conclusions The choice of donor nerve affects the chance of attaining BMRC ≥4 in upper trunk reconstruction. For patients with pan plexus injuries, delay to neurotisation appears to be detrimental to motor outcome. This information may help clinicians and patients reach shared decisions about the choice of donor nerve(s) and the timing of surgery.

Optimal Donor Nerve to Restore Elbow Flexion After Traumatic Brachial Plexus Injury: A Systematic Review and Meta-Analysis.

Traumatic brachial plexus injuries (BPIs) often lead to devastating upper extremity deficits. Treatment frequently prioritizes restoring elbow flexion through transfer of various donor nerves; however, no consensus identifies optimal donor nerve sources. To complete a meta-analysis to assess donor nerves for restoring elbow flexion after partial and total BPI (TBPI). Original English language articles on nerve transfers to restore elbow flexion after BPI were included. Using a random-effects model, we calculated pooled, weighted effect size of the patients achieving a composite motor score of ≥M3, with subgroup analyses for patients achieving M4 strength and with TBPI. Meta-regression was performed to assess comparative efficacy of each donor nerve for these outcomes. Comparison of the overall effect size of the 61 included articles demonstrated that intercostal nerves and phrenic nerves were statistically superior to contralateral C7 (cC7; P = .025, <.001, respectively) in achieving ≥M3 strength. After stratification by TBPI, the phrenic nerve was still superior to cC7 in achieving ≥M3 strength (P = .009). There were no statistical differences among ulnar, double fascicle, or medial pectoral nerves in achieving ≥M3 strength. Regarding M4 strength, the phrenic nerve was superior to cC7 (P = .01) in patients with TBPI and the ulnar nerve was superior to the medial pectoral nerve (P = .036) for partial BPI. Neurotization of partial BPI or TBPI through the intercostal nerve or phrenic nerve may result in functional advantage over cC7. In patients with upper trunk injuries, neurotization using ulnar, median, or double fascicle nerve transfers has similarly excellent functional recovery.

Long head function preserving modification of Somsak’s nerve transfer for the reanimation of shoulder abduction in the adult upper partial brachial plexus injuries: a cadaver and clinical study

We modified the conventional Somsak procedure to preserve the innervation to the long head of triceps, which is an indispensable component of inferior and posterior shoulder stability. The latter is also an extensor and external rotator of the shoulder. Our modification is also based on the finding that normal force of the reinnervated muscle could be achieved with just one-third of the axonal population. Shoulder abduction and external rotation are second priority in adult brachial plexus injury (ABPI) treatment. The aim of this study is to evaluate the functional outcomes of our modification of Somsak’s procedure A preliminary cadaver study was conducted by us to study the anatomy of the donor nerve (the nerve to the long head of triceps-NLHOT) and feasibility for function preserving nerve transfer to the anterior branch of the axillary nerve. We followed this with a retrospective study (2007 to 2017) in which the documents of 46 closed adult upper partial brachial plexus injuries (AUPBPI) patients who had undergone only the modified Somsak’s procedure for the shoulder animation were assessed. All patients had levels 1, 2, and 3 preganglionic or wide gap postganglionic injuries involving the C5 and C6 spinal nerves. The patients also had a simultaneous target neurotization procedure for elbow flexion. The cadaver study highlighted the vasa nervorum and branching patterns of the axillary nerve and NLHOT. The cadaver study also established the ways and means of harvesting the vascularized size-matched branch of NLHOT facilitating target neurotization to the anterior branch of the axillary nerve. On evaluation with the institution objective assessment score, 42 patients (91.3%) had grade 4 scores and four patients (8.7%) had grade 3 scores (p < 0.05). At the end of the follow-up period, patients were assessed with the institutional subjective assessment score, which showed that 43 patients (93.5%) had grade “A” and three patients (6.5%) had grade “B” scores (p < 0.05). Preserving the innervation of the long head of triceps bestows good shoulder stability. A diligent intraneural dissection along the nerve to the long head of triceps fetches a branch of adequate size and length and possibly with a sufficient number of regenerating axons, facilitating a tensionless coaptation of vascularized nerve ends and resulting in useful functional outcomes. Thus the modified Somsak’s procedure can be a useful addendum in the shoulder animation of AUPBPI patients. Level of evidence: Level III, therapeutic study

Elbow Flexion Reconstruction in Brachial Plexus Avulsion Injuries - Results with Intercostal Nerve and Distal Nerve Transfers.

Background: The neural surgical options for reconstruction of elbow flexion in brachial plexus injuries depend on the availability of nerve donors. In upper-type avulsion injuries, the ulnar or median nerves, when intact, are reliable intra-plexal donor nerves for transfers to the biceps muscle. In complete avulsion injuries, donors are limited to extra-plexal sources, such as intercostal nerves (ICNs). Methods: We reviewed our results of ICN and partial distal nerve (ulnar or median) transfers for elbow flexion reconstruction in patients with brachial plexus avulsion injuries. The time taken for recovery of elbow flexion strength to M3 and the final motor outcome at 2 years were compared between both groups. Results: 38 patients were included in this study. 27 had ICN transfers to the musculocutaneous nerve (MCN), 8 had partial ulnar nerve transfers and 3 had partial median nerve transfers to the MCN's biceps motor branch. The mean time interval from injury to surgery was 3.6 months. Recovery of elbow flexion was observed earlier in the distal nerve transfer group (p < 0.05). Overall, success rates were higher in patients with distal nerve transfers (100%), compared to ICN transfers (63%) at 2 years (p = 0.018). Patients with distal nerve transfers achieved a higher final median strength of M4.0 [Interquartile range (IQR) 3.5-4.5], compared to M3.5 (IQR 2.0-4.0) in the ICN group (p = 0.031). In the subgroup of patients with upper-type brachial plexus injuries, there were no significant differences in motor outcomes between the ICN versus distal nerve transfers group. Conclusions: In our entire cohort, patients with distal nerve transfers had faster motor recovery and better elbow flexion power than patients with ICN transfers. In patients with partial brachial plexus injuries, outcomes of ICN transfers were not inferior to distal nerve transfers.

Feasibility of the Oberlin Procedure in Late Presentation Cases of C5-C6 and C5-C7 Brachial Plexus Injuries in Adults.

Background: Oberlin et al presented a new technique for nerve transfer that completely changed the prognosis of patients with brachial plexus injury. Currently, most of the literature addresses cases submitted to early surgical intervention, before 12 months from injury, showing consistent good results. The aim of this study was to evaluate the feasibility of the Oberlin procedure in late presentation cases (≥12 months), comparing the elbow flexion strength with patients operated earlier. Methods: We retrospectively reviewed 49 patients with partial brachial plexus injuries submitted to the Oberlin procedure. They were divided into 2 groups. Group A included 39 patients operated with <12 months of injury. The mean postoperative follow-up was 22.53 months. The interval from injury to surgery varied from 4 to 11 months (±8.45 months). Group B included 10 patients with surgery ≥12 months after injury. The mean postoperative follow-up was 32 months. The interval from injury to surgery ranged from 12 to 19 months (±15.4 months). Patients were evaluated monthly after surgery and the elbow flexion strength was measured using the British Medical Research Council scale. Results: In Group A, 24 patients presented with either good (M3) or excellent (M4) elbow flexion strength. In Group B, 9 patients presented with either good (M3) or excellent (M4) elbow flexion strength. A significant difference was not seen in the postoperative elbow flexion strength among the 2 groups. Conclusion: Biceps reinnervation with the Oberlin procedure is still feasible and should be attempted after more than 12 months of injury in partial brachial plexus injuries.

Reanimation of triceps muscle using ulnar nerve fascicle transfer to the nerve to long head of the triceps muscle

Triceps muscle serves an important role in extension of the elbow. Its action is required for reaching out objects without using the trunk. Elbow extension is an important function for natural stabilization of the elbow. The aim of this study was to evaluate restoration of elbow extension in adults suffering triceps muscle palsy with various causes, by using transfer of a fascicle of ulnar nerve to the long head of triceps branch of the radial nerve. In the present case series, 7 patients with partial brachial plexus injury or posterior cord injury, where triceps muscle was involved, were subjected to motor fascicle of ulnar nerve transfer to the nerve to long head of triceps for restoration of elbow extension. Follow-ups, including EMG-NCV (electromyography-nerve conduction velocity) 6 and 12months after surgery and elbow extension muscle strength using MRC grading, were carried out. Six patients (85.71%) achieved a functional muscle strength of M4 for their elbow extension. In all of the patients, re-innervation was discovered using EMG-NCV. This surgical technique (ulnar nerve fascicle transfer to long head of thetriceps) for improving elbow extension is promising in patients with brachial plexus injury.

Bilateral Suprascapular Nerve Injury and Novel Technique of Nerve Transfers for Restoration of External Rotation: Case Report

Complex brachial plexus and peripheral nerve injuries can be challenging to evaluate and treat, especially in the face of novel pathology. To describe the diagnosis of bilateral suprascapular nerve injury, the unique surgical anatomy, and the novel use of a distal nerve transfer to re-establish external rotation. To the best of our knowledge, bilateral suprascapular nerve injury has not previously been reported. The authors describe the physical examination and electrodiagnostic and imaging work-up for elucidating complex injury patterns and present a procedure for reinnervating the infraspinatus muscle. A 48-yr-old man presented with profound, right-sided, partial brachial plexus injury incurred 5 mo earlier in a motorcycle accident. Imaging demonstrated atrophy and severe edema within the bilateral supraspinatus and infraspinatus muscles. Needle electromyography depicted no motor units and insertional activities in bilateral infraspinatus muscles, consistent with bilateral suprascapular nerve injury. Along with brachial plexus repair, the patient underwent transfer of a distal branch of the spinal accessory nerve to the inferolateral branch of the suprascapular nerve to the infraspinatus muscle. At 16 mo, he had recovered strong restoration of shoulder external rotation. Systematic evaluation can assist in defining complex pathology, particularly with previously unreported types. In this case, predominant injury was inflicted upon the branch innervating the infraspinatus. Highly focal nerve transfers can achieve substantial restoration of external rotation.

An All-Anterior Approach for Quadruple Nerve Transfer for Upper Trunk Brachial Plexus Injuries

The most commonly performed nerve transfers in upper trunk (UT) or partial brachial plexus injuries (BPIs) include the spinal accessory nerve to suprascapular nerve, Oberlin, and, lately, radial nerve (RN) (branch to triceps) to axillary nerve (AN) transfers. Routinely, the former 3 procedures are performed through an anterior approach (supraclavicular plus infraclavicular), while the triceps branch of the RN-AN transfer has been performed through a posterior approach with the patient in either the prone or semilateral position, which requires a separate incision in the posterior arm. The aim of the present study was to report the outcomes for 4 cases of quadruple nerve transfers performed for UT BPI using an all-anterior approach. The functional outcomes of 4 consecutive cases of UT BPI treated using an all-anterior approach were analyzed in terms of improvement in motor power and range of motion at the shoulder and elbow joints. The mean age was 27.5 years (range, 16-40). All had sustained injuries from road traffic accidents. The mean injury to surgery interval was 4.5 months (range, 3-6). Of the 4 patients, 2 each had pre- and postganglionic injuries. All 4 patients had 0 of M0 power in shoulder abduction and external rotation, and elbow flexion. At a mean follow-up of 28.6 months, the average shoulder abduction was 157°, with an average of 82° of external rotation. The mean elbow flexion was 104°. This technique appears to be feasible, with good-to-excellent outcomes achieved without requiring a separate posterior arm incision for the RN-AN transfer.

Patterns of Brachial Plexus Stretch Palsy in a Prospective Series of 565 Surgically Treated Patients

To report the distribution of the different patterns of stretch brachial plexus injuries (BPIs) in a retrospective cohort of patients operated at our institution during an 11-year period. From September 2002 to June 2012, we evaluated and operated on 565 patients with traction injuries of the brachial plexus. Average age was 26.8 years (SD ±9.3 years); the interval between the injury and surgery was 5.4 months (SD ±2.8 months). The pattern of injury was defined based on data obtained from a standardized clinical examination, preoperative helical computed tomography myelography after intradural contrast injection, surgical findings, and intraoperative electric stimulation. Supraclavicular injuries accounted for 91% of all cases (N= 512) whereas 9% of injuries were infraclavicular. Within the supraclavicular injuries, 50% of cases involved the entire plexus and in 12% there was avulsion of all 5 roots. Among them, 94% involved the upper plexus (C5 to C6 ± C7 ± C8), and 6% the lower plexus (C8 to T1 ± C7). C5 to C6 injuries accounted for 23% of partial BPI, C5 to C7 19%, C5 to C8 52%, C7 to T1 4%, and C8 to T1 2%. The most relevant findings of this study were that most panplexal BPIs showed at least one graftable root, there was a high prevalence of C5 to C8 BPI, C7 to T1 root injury wasthe most common pattern of lower type of injury, and infraclavicular BPI was uncommon. Diagnostic IV.

Brachial plexus injury: are we doing enogh?

Introduction and Objective: Repair of Brachial plexus injury is a neglected art in developing countries like ours. We discuss here various case scenarios managed at our centre and the challenges involved.Materials and Methods: Cases with brachial plexus injury attending our OPD were included in this study. Different neurotisation and repair techniques were used depending on the situations. Outcome in form of improvement in function and relief of pain were evaluated.Results: During last 5 year (July 2010 to September 2015), 100 patients with brachial plexus injury were evaluated in our outpatient OPD. Majority of them were too late to be offered any treatment. 20% patients had neuropraxia and were managed conservatively. 41 patients were operated. 19 were complete brachial plexus injury and underwent extraplexal neurotisation procedures. 11 were partial brachial plexus injury and had intraplexal neurotisation procedures. Neurolysis were done as required. 11 case of peripheral nerve injury was managed with direct repair and neurolysis. Almost all patients with neuropraxia had good recovery in follow up. Patients who underwent surgical intervention had good recovery in terms of recovery recovery of function and relief of pain.Conclusion: Due to lack of awareness and socioeconomic reasons, majority of nepalese people approach very late for surgical options. Benefit of the brachial plexus repair depends upon factors like type of injury, timing of intervention, surgical technique and post operative follow up. We had good outcome in our patients who came early and continued on follow up.

Nerve transfer in the management of upper extremity paralysis after brachial plexus and central neurologic injuries: Experience of Huashan

Huashan Hospital receives the largest population of brachial plexus injury patients in China. Here, we presented our latest follow-up cases and newest strategies of nerve transfer in different types of brachial plexus injury, including both supra- and infra-clavicular injuries. The most challenging brachial plexus avulsion injuries (BPAI) involving partial (upper/lower) or global plexus will be mainly discussed. We will focus on optimized combination of nerve transfer strategies for perusing the best outcomes, especially the distal functions. In partial brachial plexus injury patients, several intra-brachial plexus donor nerves are utilized, such as brachialis branch of the musculocutaneous nerve, superior motor branch of the median nerve, partial ipsilateral C7 nerve. The extended applications of contralateral C7 nerve transfer and full-length phrenic nerve transfer will be specifically introduced. Moreover, special brachial plexus injury types with non-classical nerve transfer surgery are also included. As the central nervous system plays an important part in the rehabilitation process of peripheral nerve injury, we further explored the relationship between brachial plexus injury-repair (transfer) and brain reorganization. Based on our previous researches, the contralateral C7 nerve transfer shows the capacity of inducing the compensation potential of the intact hemisphere after unilateral central neurologic injury (e.g. cerebral palsy, traumatic brain injury, stroke). The contralateral C7 nerve transfer was thus used in treating hemiplegic upper extremities and applied in more than 50 patients. The preliminary results of these cases will also be presented.

Thoracodorsal nerve transfer for triceps reinnervation in partial brachial plexus injuries.

To report the clinical outcomes of thoracodorsal nerve (TDN) transfers to the triceps motor branches for elbow extension restoration in patients with partial brachial plexus injuries (BPI). Eight male patients of mean age 23 years and suffering from a partial BPI underwent direct coaptation of the TDN to the nerve of the upper medial and long heads of the triceps, an average 6 months after their accident. Seven patients achieved M4 elbow extension strength and one patient M3, according to the BMRC scale, after a mean follow-up of 21 months. Direct TDN transfer might be a valid surgical procedure for the restoration of elbow extension in patients with partial BPI.

Restoration of shoulder abduction function by direct muscular neurotization with the phrenic nerve fascicles and nerve grafts: A case report

In this report, we describe the first case of using the partial phrenic nerve transfer and direct muscular implantation into the deltoid muscle for restoration of the shoulder function and stability. A patient suffering from the partial brachial plexus injury with absent axillary nerve underwent reconstructive surgery by an end-to-end nerve coaptation using two fascicles of the phrenic nerve and two autologous nerve grafts, and direct implantation of nerve grafts into the deltoid muscle. Eighteen months after the procedure, we found a functioning biceps with 90 degrees elbow flexion against gravity and 40 degrees shoulder abduction with satisfactory shoulder stability. Electrophysiology revealed reinnervation potentials in the deltoid and biceps muscle. This case demonstrates a satisfactory result after using transfer of the partial ipsilateral phrenic nerve in combination with muscular implantation to restore shoulder abduction and stability. We recommend the described techniques in cases without other reconstructive options. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.

Extrapleural Apical Fluid Collection: An Important Sign on Plain X-ray Suggesting a Pre-ganglionic Brachial Plexus Injury

Forty of 136 consecutive patients referred for management of brachial plexus injuries had closed supraclavicular injuries. The results of the initial chest X-rays were available for 29 patients. Nine had avulsion of the C8 and T1 nerve roots from the spinal cord. Eight cases had MR confirmation of lower root avulsion, six of these cases were confirmed surgically and none had any long-term clinical recovery. Twenty had partial brachial plexus injuries without avulsion of these roots. Seven of nine patients with avulsion of C8 and T1 had an extrapleural apical fluid collection. One of these had a fractured first rib. Two of 20 without avulsion had an extrapleural apical fluid collection. Both had fractured the first rib. The difference in incidence of extrapleural apical fluid collection between the two groups, excluding those cases with first rib fractures, was statistically significant. Without a first rib fracture, an ipsilateral extrapleural apical haematoma on a plain chest X-ray of patients with brachial plexus injury strongly suggests pre-ganglionic injury to the lower roots.

RE: Nerve transfers in children with traumatic partial brachial plexus injuries

MicrosurgeryVolume 28, Issue 7 p. 580-580 Letter to the Editor RE: Nerve transfers in children with traumatic partial brachial plexus injuries Jean-Noël Goubier M.D., Ph.D., Corresponding Author Jean-Noël Goubier M.D., Ph.D. International Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceInternational Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceSearch for more papers by this authorFrédéric Teboul M.D., Frédéric Teboul M.D. International Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceSearch for more papers by this authorEllada Papadogeorgou M.D., Corresponding Author Ellada Papadogeorgou M.D. jngoubier@gmail.com International Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceInternational Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceSearch for more papers by this author Jean-Noël Goubier M.D., Ph.D., Corresponding Author Jean-Noël Goubier M.D., Ph.D. International Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceInternational Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceSearch for more papers by this authorFrédéric Teboul M.D., Frédéric Teboul M.D. International Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceSearch for more papers by this authorEllada Papadogeorgou M.D., Corresponding Author Ellada Papadogeorgou M.D. jngoubier@gmail.com International Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceInternational Center of Hand Surgery, Clinique du Parc Monceau, Paris, FranceSearch for more papers by this author First published: 10 September 2008 https://doi.org/10.1002/micr.20558AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume28, Issue72008Pages 580-580 RelatedInformation

Nerve transfers in children with traumatic partial brachial plexus injuries

Brachial plexus trauma is a rare condition in children except for obstetrical lesions, for which nerve grafting is generally proposed. Two children (9 and 12 years old) with C5 and C6 traumatic brachial plexus avulsion lesions are presented, where elbow flexion and shoulder abduction and external rotation were the functions to be restored. Nerve transfers have been performed. Shoulder abduction was restored by an accessory-to-suprascapular nerve transfer in one patient, while the triceps long head motor branch was transferred to the axillary nerve in both patients. Fascicles of the ulnar and median nerve were transferred respectively to the biceps muscle nerve and the brachialis motor branch. At 11 months follow-up, the elbow flexion scored M4 and the shoulder abduction recovered in both patients. No complications were observed. Nerve transfers currently used in adult patients may be applied in children with traumatic partial brachial plexus palsies.

Nerve transfers in children with traumatic partial brachial plexus injuries

MicrosurgeryVolume 28, Issue 7 p. 578-579 Letter to the Editor Nerve transfers in children with traumatic partial brachial plexus injuries Marcus Spies M.D., Ph.D., Corresponding Author Marcus Spies M.D., Ph.D. spies.marcus@mh-hannover.de Department of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyDepartment of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanySearch for more papers by this authorChristine Radtke M.D., Christine Radtke M.D. Department of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanySearch for more papers by this authorPeter M. Vogt M.D., Ph.D., Peter M. Vogt M.D., Ph.D. Department of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanySearch for more papers by this author Marcus Spies M.D., Ph.D., Corresponding Author Marcus Spies M.D., Ph.D. spies.marcus@mh-hannover.de Department of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanyDepartment of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanySearch for more papers by this authorChristine Radtke M.D., Christine Radtke M.D. Department of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanySearch for more papers by this authorPeter M. Vogt M.D., Ph.D., Peter M. Vogt M.D., Ph.D. Department of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, GermanySearch for more papers by this author First published: 19 August 2008 https://doi.org/10.1002/micr.20552Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume28, Issue72008Pages 578-579 RelatedInformation