gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Primary reconstruction of the injured adult brachial plexus: The role of nerve-transfer procedures

Die primäre Rekonstruktion des Plexus brachialis: die Rolle des Nerventransfers

Meeting Abstract

Suche in Medline nach

  • corresponding author Kartik G. Krishnan - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden
  • T. Pinzer - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden
  • G. Schackert - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.05.09

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0199.shtml

Veröffentlicht: 23. April 2004

© 2004 Krishnan et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Injuries to the brachial plexus are becoming more common in a century of sportive and high velocity means of transport. Whereas a minority of incomplete plexus injuries shows a tendency towards spontaneous recovery, the majority require one or more reconstructive surgeries. In a variety of cases no [usable] nerve roots are found for reconstructions. Nerve transfers find their application in these. The commonly used donor nerves in adults are the spinal accessory (XI), intercostal (IC), long thoracic (LT) nerves; more rarely the phrenic nerve (PN) and contralateral C7 (CC7) root. We report on our experience with the use of XI, IC and LT nerves.

Methods

Since 2000, we have examined 63 brachial plexus lesions (54 males and 9 females) of various degrees and etiology in our outpatient clinic. Here, we analyze primary nerve reconstruction procedures in 42 of these cases. XI – suprascapular (SSN) nerve transfer was required in 36 patients; IC or LT – musculocutaneous (MCN) nerve transfer in 29 cases. The mean latency from injury to surgery was 4 months (0-12 months). We have never used the PN or CC7 as nerve donors. Clinical follow-up of 2 years or more is available only in 19 patients; 23 patients were followed up for one year after surgery. Very few plexus injuries were similar to each other; reconstruction procedures had to be individually tailored. Thus to establish a statistical correlation between the numerous factors influencing regeneration and the nerve regeneration pattern is impossible in our group of patients.

Results

The transfer of IC or LT to MCN conducted immediately or within 3 months after injury (18 patients) showed excellent (M4+) or good (M4) elbow flexion within 1 year after surgery. Secondary functional procedures were requried in patients (n=12) with long surgical latency (more than 5 months). A similar result applies to the XI – SSN transfer; however, this transfer never produced a M4+ strength irrespective of the latency.

Conclusions

(a) Early surgery is recommended in brachial plexus injuries; (b) Transfer of IC or LT is one of the valuable methods, especially when proximal intraplexual elements are not available/adequate. However, the results depend on many factors, e.g., age, latency, technique etc.