Summary
Restoration of elbow flexion is one of the priorities in brachial plexus palsy, as
this function brings the hand to the mouth. This study analyses the results of musculocutaneous
nerve reconstruction in 194 patients with devastating paralysis. Results were analyzed
in relation to denervation time, severity score, length of nerve grafts, and donor
nerves used.
Between 1978 and 2006, 194 post-traumatic plexopathy patients underwent musculocutaneous
nerve reconstruction. 298 motor donors were used in 175 patients while 19 patients
had microneurolysis. There were 104 intraplexus motor donors; 124 intercostal nerves
were transferred in 39 patients; direct coaptation was performed in 31 patients and
three or more intercostals were transferred in 33 patients; 16 patients underwent
musculocutaneous to musculocutaneous repair. 144 patients had interposition nerve
grafts. The mean follow-up was 4.48 ± 2.78 years.
Results were good or excellent (≥M3+) in 52.53% of patients with more than 70° of
elbow flexion. Patients, who were operated on less than 4 months from injury, with
high severity score, attained significant better results than late cases with multiple
root avulsions. Intraplexus donors have direct influence on biceps recovery, achieving
significant better results than extraplexus donors. Intercostal nerves are an alternative
source in avulsion injuries. The use of 3 intercostals with direct coaptation yielded
optimal elbow flexion.
Musculocutaneous nerve reconstruction is one of the priorities in upper limb reanimation.
Functional outcomes are influenced by the age of the patient, severity of plexus lesion,
denervation time, and type of reconstruction. Early surgery is recommended.
Keywords
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References
- The surgical treatment of brachial plexus injuries in adults.Plast Reconstr Surg. 2005; 106: 1097-1122
- Neurotization in brachial plexus injuries: Indication and results.Clin Orthop. 1988; 237: 43-56
- Biomechanics of the elbow.in: Bernard F. Morrey M.D. The elbow and its disorders. 2nd ed. WB Saunders Company, 1993: 53-72
- Anatomy of the elbow joint.in: Bernard F. Morrey M.D. The elbow and its disorders. 2nd ed. WB. Saunders Company, 1993: 16-52
- Brachial plexus.in: Williams L.P. Bannister H.L. Gray’s Anatomy: the anatomical Basis of Medicine & surgery. 38th ed. Churchill Livingstone, Edinburg1995: 1266-1275
- Rupture of the distal tendon of the biceps branchii. A biomechanical study.J Bone Jt Surg Am. 1985; 67: 418-421
- Elbow strength and endurance in patients with a ruptured distal biceps tendon.J Shoulder Elbow Surg. 2010; 19: 184-189
- A biomechanical study of normal functional elbow motion.J Bone Jt Surg Am. 1981; 63: 872-877
- An anatomic study of the musculocutaneous nerve and its relationship to the coracoid process.Clin Orthop Relat Res. 1989; 244: 166-171
- Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis.Plast Reconstr Surg. 1999; 104: 1221-1240
- The surgical treatment of brachial plexus injuries in adults.Plast Reconstr Surg. 2007; 119: 73e-92e
- Epidemiology of brachial plexus injuries in a multitrauma population.Neurosurgery. 1997; 40: 1182-1188
- Brachial plexus root avulsion.World J Surg. 2001; 25: 1049-1061
- Brachial plexus injury: factors affecting functional outcome in spinal accessory nerve transfer for the restoration of elbow flexion.J Neurosurg. 2003; 98: 307-312
- Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion.J Hand Surg (Am). 2005; 30A: 978-985
- Comparison of single vs. Double nerve transfers for elbow flexion after brachial plexus injury.Plast Reconstr Surg. 2010; 126 ([publish ahead of print])
- Shoulder tendon transfer options for adults patients with brachialplexus injury.J Hand Surg. 2010; 35A: 1211-1219
- Reconstruction of complete palsies of the adults brachial plexus by root grafting using long grafts and nerve transfers to target nerves.J Hand Surg (Am). 2010; 35A: 1640-1646
- Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries: evaluation of 66 patients.J Hand Surg (Am). 1992; 17A: 822-828
- Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients (excluding obstetric brachial plexus injury).J Hand Surg (Am). 1993; 18A: 285-291
- Complete traumatic brachial plexus palsy.J Bone Jt Surg (Am). 1999; 81: 20-28
- A comparison of intercostals and partial ulnar nerve transfers in restoring elbow flexion following upper brachial plexus injury (C5-C6 ± C7).J Hand Surg. 2010; 35A: 1297-1303
- The influence of pre-surgical delay on functional outcome after reconstruction of brachial plexus injuries.J Plast Reconstr Aesthet Surg. 2009; 62: 472-479
- Vascularized ulnar nerve graft: 151 reconstruction for posttraumatic brachial plexus palsy.Plast Reconstr Surg. 2009; 123: 1276-1291
- Nerve grafting in brachial plexus injuries. Results of free grafts in 90 patients.J Bone Jt Surg (Br). 1996; 78-B: 754-758
- Musculocutaneous neurotization to restore elbow flexion in brachial plexus paralysis.Microsurgery. 2006; 26: 325-329
- Nerve transfer to biceps muscle using a part of ulnar nerve for c5- c6 avulsion of the brachial plexus: anatomical study and report of four cases.J Hand Surg (Am). 1994; 19: 232-237
- Results of nerve transfers to the musculocutaneous and axillary nerves.Neurosurgery. 2000; 46: 93-103
- Long-tern outcome of contralateral c7 transfer: a report of 32 cases.Chin Med J. 2002; 115: 866-868
- Use of the phrenic nerve for brachial plexus reconstruction.Clin Orthop Rel Res. 1996; 323: 119-121
- Outcomes of surgical treatment of brachial plexus injuries using nerve grafting and nerve transfers.J Reconstr Microsurg. 2002; 18: 7-15
- Selective contralateral c7 transfer in posttraumatic brachial plexus injuries: a report on 56 cases.Plast Reconstr Surg. 2009; 123: 927-938
- Restoration of elbow flexion in brachial plexus avulsion injury: Comparing spinal accessory nerve transfer with intercostal nerve transfer.J Hand Surg. 1999; 24A: 571-577
- Full length phrenic nerve transfer by means of video- assisted thoracic surgery in treating brachial plexus avulsion injury.Plast Reconstr Surg. 2002; 110: 104-109
- Intercostal nerve transfer for elbow flexion.Tech Hand Up Extr Surg. 2001; 5: 136-140
- Evaluation of intercostals to musculocutaneous nerve transfer in reconstructive brachial plexus surgery.J Neurosurg. 1998; 88: 266-271
- Nerve transposition for the restoration of elbow flexion following brachial plexus avulsion injuries.J Neurosur. 1990; 72: 59-64
- Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature.J Hand Surg (Am). 2001; 26A: 303-314
- Thoughts on neurotization or nerve transfers in irreparable nerve lesions.Clin Plast Surg. 1984; 11: 153
- Nerve transfer in brachial plexus traction injuries.J Neurosurg. 1992; 76: 191-197
Article info
Publication history
Published online: November 09, 2011
Accepted:
August 19,
2011
Received:
April 14,
2011
Identification
Copyright
© 2011 Published by Elsevier Inc.
