gms | German Medical Science

Objective: Brachial plexus injuries (BPIs) are complex and challenging injuries that can result in significant loss of function in the involved upper extremity. The purpose of this study was to provide useful guidance for the management of BPIs.

Method: Twenty-two patients who underwent intercostal nerve transfer (ICNT) only or ICNT with additional spinal accessory nerve transfer (SANT) by sural nerve graft interposition for traumatic BPIs were retrospectively studied from 2005 to 2014. The Medical Research Council scale was used for outcome assessment. Follow-up was performed for at least 1 year to confirm neurological outcomes.

Results: Seventy-seven percent of all patients gained motor grade improvements after surgery; however, patients in the combined surgery group, who underwent ICNT and SANT(mean=2.2), had better motor grade scale improvements than patients in the single-operation group, who underwent only ICNT(mean=1.083) (P= 0.030). Moreover, a mean time to surgery of less than 6 months resulted in better outcomes than a mean time to surgery of greater than 6 months. Reinnervation of the musculocutaneous nerve was demonstrated in 92.8% of the patients who underwent surgery within the first 6 months post injury, in 40% of the patients with a delay of between 6 and 12 months, and none of the patients who underwent surgery after 12 months(P= 0.004).

Conclusions: This study validated that ICNT with SANT is effective for reconstructing musculocutaneous nerves in patients with BPIs. Surgery should be performed as soon as possible after injury at least 6 months.