Artikel
The use of radial sensitive nerve graft in neurotization of musculocutaneous nerve for treatment of braquial plexus avulsions
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Autoren
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Paulo Randal Pires Júnior
- Hospital Madre Teresa, Belo Horizonte, Brazil
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Marcella Rodrigues Costa
- Hospital Madre Teresa, Belo Horizonte, Brazil
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Gustavo Pacheco Martins Ferreira
- Hospital Maria Amélia Lins, Belo Horizonte, Brazil
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Rodrigo José De Resende Santos
- Hospital Maria Amélia Lins, Belo Horizonte, Brazil
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Brachial plexus trauma is increasingly prevalent, and restoring active elbow flexion is a treatment priority. The most effective techniques, in relation to the avulsion lesions, involve the neurotization for the biceps-brachial muscle, either with graft or nerve transfer.
This study presents a surgical technique that uses the radial sensitive nerve as a graft for the neurotizations of musculocutaneous nerve from accessory nerve in the treatment of avulsions of the brachial plexus to restore elbow flexion, and evaluates the results obtained with the technique.
Methods: A cohort study of patients with traumatic brachial plexus lesion submitted to this surgical technique and followed at a reference hospital from June/2009 to August/2017. Twenty-two patients were included, reassessed regularly for a period of 2 years after surgery. The elbow flexion strength was classified according to the Medical Research Council scale which ranks from 0 (no contraction) to 5 (normal motor force).
Results and Conclusions: The majority were male (94.4%) and the age ranged from 16 to 45 years. The most prevalent age group was 20 to 29 years. The majority of lesions (18 cases, 81.8%) were with total impairment. The mean time between the trauma and the surgical procedure was 195 days. The results were evaluated after 3, 6, 12 and 24 months. At the end of this study, it was observed that 54.5% of patients had M4 strength and 77.2% of good results with effective force M3 or higher.
Radial sensory nerve grafting allows the grafting of up to 25 cm grafts, presents a convenient surgical approach and close to the donor site facilitating per operative technique. In addition, it does not generate sequelae and there is no postoperative functional loss, since the patient already presents the deficit previously in the total lesions of the plexus. The present study presents similar results to the literature: the review found success rates of 51.3% to 100% in neurotizations for the musculocutaneous nerve (force equal to or greater than M3).
The radial nerve graft technique showed several advantages in the surgical procedure, in addition to success rates similar to other grafts already reported in the literature, which favors this procedure.
