gms | German Medical Science

Objectives/Interrogation: For incomplete injuries of the brachial plexus intraplexal nerve transfers as the Oberlin transfer are successful and well accepted. In case of complete lesions extraplexal transfers are necessary. Different donor nerves are under ongoing discussion. The alternatives to intercostal nerve transfers are nerve grafts in selected cases, transfers of the accessory or phrenic nerve, free muscle transfers and contralateral donors. The aim is to evaluate the extent of failures of the intercostal nerve transfers compared to Oberlin transfers.

Methods: 41 patients with brachial plexus injuries (age 15 - 60; 37 male and 4 female) were treated between January 2010 to July 2017 with reconstruction of elbow flexion by nerve transfers. Of these, 21 had intercostal nerve transfers to the musculocutaneus nerve and 20 were treated with the Oberlin transfer including modifications. In all cases with intercostal nerve transfers the terminal sensory branch was used for direct neurotization of the elbow flexor muscles. The minimum follow-up was 12 months.

Results and Conclusions: Follow up of 34 patients until October 2018 could be included in the analysis. Elbow flexion between 45 and 140° (median 97,5°) with M3 or more strength was achieved by transfer of intercostal nerves to musculocutaneus nerve with a success rate of 72,2% (13/18). The results of Oberlin-Transers showed a successful flexion of M3 or more between 80° and 140° (median 115°) in 93,8% (15/16). The median muscle force rated 4/5 MRC in both transfers.

Intercostal nerve transfers led to an useful elbow flexion in more than 70% of cases. This experience is similar to several published results and meta-analyses. One reason for these good results might be the regular use of direct muscle neurotization by the terminal sensory branch of musculocutaneous nerve. Certainly intraplexal transfers like the Oberlin transfer are more successful with reliable functional reconstruction and a shorter reinnervation latency due to shorter distance to the recipient muscle. But up to now no concept for complete plexus injuries was published with reliable better results. Therefor intercostal nerve transfers to the musculocutaneous nerve are a helpful tool in plexus surgery concepts.