Article
Primary reconstruction of the injured adult brachial plexus: The role of nerve-transfer procedures
Die primäre Rekonstruktion des Plexus brachialis: die Rolle des Nerventransfers
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Authors
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Kartik G. Krishnan
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden
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T. Pinzer
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden
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G. Schackert
- Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden
| Published: | April 23, 2004 |
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Outline
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.
