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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Simultaneous Multiple Long Sural Nerve Cable Graft with Saphenous Vein Graft and Staged Tendon Transfer for Brachial Plexus Injury with Ischemic Injury

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  • presenting/speaker Che Ho Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Young Ho Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Hyun Sik Seok - Seoul National University College of Medicine, Seoul, South Korea
  • Jihyeung Kim - Seoul National University College of Medicine, Seoul, South Korea
  • Yo Han Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Yeun Soo Kim - Seoul National University College of Medicine, Seoul, South Korea
  • Young Ju Chae - Seoul National University College of Medicine, Seoul, South Korea
  • Goo Hyun Baek - Seoul National University College of Medicine, Seoul, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1269

doi: 10.3205/19ifssh1212, urn:nbn:de:0183-19ifssh12128

Published: February 6, 2020

© 2020 Lee et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Many surgical treatments of brachial plexus injury (BPI) such nerve repair, nerve graft, and nerve transfer have been introduced over the times, but simultaneous neurovascular reconstruction for traumatic BPI with long neurovascular defects has rarely been reported. The purpose of this study was to analyze the outcome of neurovascular reconstruction associated with multiple long sural nerve cable graft, saphenous vein graft and staged tendon transfer in a patient with whole-type paralysis of BPI accompanied by ischemic injury.

Methods: A 43-year-old man who had been injured in the left axillary area by rotating drill machine visited an emergency room. His left upper extremity was completely absent in neurologic function and seemed to be pale. In surgical exploration, complete rupture in axillary nerve, musculocutaneous nerve, median nerve, ulnar nerve, and radial nerve accompanied by complete brachial artery rupture were found. Defect of axillary nerve, musculocutaneous nerve, median nerve, ulnar nerve and radial nerve was 4 cm, 4 cm, 5 cm, 6 cm, and 5 cm. So he received neurovascular reconstruction using multiple autogenous long sural nerve cable graft with autogenous great saphenous vein graft. 4 cm axillary nerve defect was reconstructed by using 2 strands of 6 cm sural nerve graft. 4 cm musculocutaneous nerve defect was reconstructed by using 3 strands of 6 cm sural nerve graft. 6 cm ulnar nerve defect was reconstructed by using 3 strands of 8 cm sural nerve graft. 5 cm median nerve defect was reconstructed by using 4 strands of 7 cm sural nerve graft, and 5 cm radial nerve defect was reconstructed by using 3 strands of 7 cm sural nerve graft. 2 years after surgery, he received opponensplasty and correction of the intrinsic-minus hand using ECRL tendon transfer were performed.

Results and Conclusions: Immediately after the 1st surgery, the ischemic limb was fully recovered, and 2 years after 1st surgery, shoulder, elbow, wrist joint and extrinsic hand muscles were completely recovered. At the last follow-up, opposition and intrinsic function of hand were improved.

Simultaneous multiple long sural nerve cable graft with vascular reconstruction in a patient with whole-type paralysis of BPI accompanied with ischemic injury is thought to be a method to restore the function of the shoulder, elbow, wrist joint and extrinsic muscle of hand. And staged tendon transfer such as opponensplasty, correction of intrinsic minus hand may be required for function restoration of intrinsic muscles of hand.