gms | German Medical Science

Objective: One of the main goals in plexus brachialis surgery is the reconstruction of elbow flexion. Because of the myoneural degeneration it is a generally accepted opinion that reconstruction should be done within the first six months after trauma. An exception to this are the nerve transfers, where healthy donor nerve fascicles are transferred directly onto an injured recipient nerve close to the motor point. We examined the outcome of our patients who received an Oberlin procedure with a delay of six or more months after trauma. The aim of this study was to estimate the maximum delay at which a nerve can be successfully reconstructed.

Method: Thirty-nine patients with traumatic total brachial plexus injury received an Oberlin transfer in our institute within the last six years (2007 – 2012). Among them, twenty-eight patients were operated with a prolonged time (six or more months) after trauma. The delay from trauma to operation varied from 6 to 37 months (average: 11 months). We investigated the medical records and examined the patients.

Results: Functional elbow flexion after operation was regained by nineteen of the patients (68%). Nearly normal muscle strength in biceps muscle (M4) was achieved by eleven patients (39%). Among the patients who had a follow-up of more than 12 months 80% recovered to functional elbow flexion (M3) and 50% received nearly full strength in biceps muscle.

Conclusions: These patients had an encouraging outcome. Even with a prolonged delay after trauma the Oberlin procedure is an excellent therapy option to reconstruct elbow flexion. In late surgery an Oberlin procedure should be considered whenever the ulnar nerve is functional. We observed that there was no maximum delay for a successful reconstruction in our patients group.