gms | German Medical Science

Objectives/Interrogation: Brachial plexus paralysis is a serious injury for which different forms of treatment are available. The aim of this study was to evaluate the functional outcome of non-vascularized long ulnar nerve graft reconstructions for the restoration of elbow flexion in patients presenting complete brachial plexus injury.

Methods: The retrospective cross-sectional study involved 14 patients who had undergone 25 non-vascularized reconstructive graft procedures during 1999-2009 at two hand surgery reference hospitals. Elbow flexion force was evaluated throughout the follow-up period (average 40 months) using the Medical Research Council muscle strength scale.

Results and Conclusions: The average age was 25 years among the predominantly male gender (92.8%), and motorcycle accidents constituted the principal (71.4%) cause of injury. The left side of the body was affected in 57.1% of cases, and denervation time varied between 4 and 14 months. Most patients presented the C5 stump intact, and this was the donor root in 14 cases. The priority outcome was elbow flexion, with ulnar nerve grafting being performed in the musculocutaneous (n=9), median (n=6), radial (n=4), axillary (n=1), posterior fascicle (radial and axillary) (n=3), and lateral fascicle (median and musculocutaneous) (n=2) nerves. Outcomes of reconstructive surgeries were considered very good (M4; n=6), good (M3; n=8), substandard (M2; n=5) and poor (M0/M1; n=6).

Non-vascularized nerve grafts can be indicated for the treatment of complete brachial paralysis. The procedure is technically easier than vascularized graft reconstructions, and does not require vascular microsurgery thus reducing the time of anesthesia and the need of microscope or magnifying glass.