gms | German Medical Science

Objectives/Interrogation: More than 50% of spinal cord injuries occur at the cervical level, leading to tetraplegia. Surgical restoration of upper limb function has the ability to improve patient autonomy and self-esteem [1]. However, these operations are underutilised in the United Kingdom and elsewhere. The authors describe a 15-year experience of deltoid to triceps transfer - using different types of interconnecting grafts - to restore elbow extension, one of the key functions to improve reaching capability and hand function.

Methods: A retrospective review of all tetraplegic patients who were considered for deltoid to triceps transfer between the years 2003 to 2017 was performed using clinical records. Pre-operative evaluation included sensory and motor testing for ICSHT (International Classification for Surgery of the Hand in Tetraplegia) grading. Patients who were offered deltoid to triceps transfer but declined the procedure were noted, with their reasons for declining where recorded.

Operation notes and follow-up records were reviewed to determine the types of grafts used, and the outcome, including early and late complications, and elbow extension power.

Results and Conclusions: We identified 26 patients who underwent deltoid to triceps transfer, 21 male and 5 female, with a mean age at the time of operation of 37 years (range 21 - 66). A total of 32 reconstructions were carried out, 20 unilateral and 6 bilateral (not simultaneous), with one late revision procedure to shorten a graft that had stretched. Thirteen were performed with the sole aim of restoring elbow extension, and 19 were combined with additional tendon transfer procedures to restore grip.

During our 15-year experience, the graft types changed from synthetic to fascia lata and most recently to tibialis anterior, respectively 18, 5, and 9 grafts, and the reasons for these changes are discussed. Early complications included haematoma, seroma, and superficial wound infection, and late problems included 2 suture granulomas and one case of graft stretching. There were no ruptures.

All but two patients achieved useful and measurable elbow extension power of MRC 3/5 or better. The two failures were both due to insufficient strength in the donor deltoid muscle, although one of the two patients felt that he had better control of his upper limb.