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J Reconstr Microsurg 2002; 18(1): 007-016
DOI: 10.1055/s-2002-19703
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Outcomes of Surgical Treatment of Brachial Plexus Injuries Using Nerve Grafting and Nerve Transfers

Tarek Abdalla El-Gammal1 , Nihal Ahmed Fathi2
  • 1Departments of Orthopedics and Traumatology, Assiut University School of Medicine, Assiut, Egypt and
  • 2Departments of Physical Medicine and Rehabilitation, Assiut University School of Medicine, Assiut, Egypt
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Publication History

Publication Date:
24 January 2002 (online)

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ABSTRACT

Between 1993 and 1998, 32 male patients with brachial plexus injuries were surgically treated. Eighteen interfascicular grafting and 71 extraplexal neurotization procedures were performed separately or in combination. Donor nerves were the intercostals, spinal accessory, phrenic, contralateral C7, and cervical plexus, in order of frequency. Patients were followed for a minimum of 24 (average, 35) months. Biceps function was best following grafting the musculocutaneous nerve itself, or neurotization with the phrenic nerve (100 percent grade 4), followed by neurotization with the intercostals (89.5 percent grade 3 or more) and last, grafting the C5 root or upper trunk (grade 3 in one of three patients). Phrenic to suprascapular neurotization produced the best results of shoulder abduction (40 to 90 degrees), followed by combined neurotization of the spinal accessory to suprascapular and phrenic to axillary (20 to 90 degrees). Sensory recovery over the lateral forearm and palm varied from S2 to S3+, according to the method of reconstruction.

KEYWORD

Brachial plexus - neurotization - phrenic nerve - intercostals - contralateral C7

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