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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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Publikationsdatum:
24. Januar 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

REFERENCES

  • 1 Millesi H. Brachial plexus injuries: nerve grafting.  Clin Orthop . 1988;  237 36
    PubMedGoogle Scholar
  • 2 Taylor G I, Ham F J. The free vascularized nerve graft: a further experimental and clinical application of microvascular techniques.  Plast Reconstr Surg . 1976;  57 413
    CrossrefPubMedGoogle Scholar
  • 3 Birch R, Dunkerton M, Bonney G, Jamieson A M. Experience with free vascularized ulnar nerve graft in repair of supraclavicular lesions of the brachial plexus.  Clin Orthop . 1989;  237 96
    PubMedGoogle Scholar
  • 4 Breidenbach W C, Terzis J K. Vascularized nerve grafts: an experimental and clinical review.  Ann Plast Surg . 1987;  18 137
    PubMedGoogle Scholar
  • 5 Narakas A O. Neurotization in the treatment of brachial plexus injuries. In: Gelberman R (ed): Operative Nerve Repair and Reconstruction.Philadelphia: Lippincott Williams and Wilkins Company, 1991
    Google Scholar
  • 6 Seddon L. Nerve grafting.  J Bone Joint Surg . 1966;  45-B 447
    PubMedGoogle Scholar
  • 7 Kotani P T, Matsuda H, Suzuki T. Trial surgical procedures of nerve transfers to avulsion injuries of plexus brachialis.  Excerpta Med . 1972;  291 348
    PubMedGoogle Scholar
  • 8 Tsuyama N, Hara T. Intercostal nerve crossing as a treatment of irreparably damaged whole brachial plexus. In: Nobel J, Galasko CSB (eds): Recent Developments in Orthopaedic Surgery Manchester: Manchester University Press 1988: 169
    Google Scholar
  • 9 Allieu Y, Cenac P. Neurotization via the spinal accessory nerve in complete paralysis due to multiple avulsion injuries of the brachial plexus.  Clin Orthop . 1988;  237 67
    PubMedGoogle Scholar
  • 10 Gu Y D, Ma M K. Use of the phrenic nerve for brachial plexus reconstruction.  Clin Orthop . 1996;  323 119
    CrossrefPubMedGoogle Scholar
  • 11 Gu Y D, Chen D S, Zhang G M. Long term functional results of contralateral C7 transfer.  J Reconstr Microsurg . 1998;  14 57
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Birch R. Brachial plexus injuries.  J Bone Joint Surg . 1996;  79B 986
    PubMedGoogle Scholar
  • 13 Chuang D C, Epstein M D, Yeh M C, Wei F C. Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients (excluding obstetric brachial plexus injuries).  J Hand Surg . 1993;  18A 285
    PubMedGoogle Scholar
  • 14 Ihara K, Doi K, Sakai K. Restoration of sensibility in the hand after complete brachial plexus injury.  J Hand Surg . 1996;  21A 381
    PubMedGoogle Scholar
  • 15 Bentolila V, Nizard R, Bizot P, Sedel L. Complete traumatic brachial plexus palsy: treatment and outcome after repair.  J Bone Joint Surg . 1999;  81A 20
    PubMedGoogle Scholar
  • 16 Terzis J K, Marios D V, Soucacos P N. Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis.  Plast Reconstr Surg . 1999;  104 1221
    CrossrefPubMedGoogle Scholar
  • 17 Nagano A, Yamamoto S, Mikami Y. Intercostal nerve transfer to restore upper extremity functions after brachial plexus injury.  Ann Acad Med Singapore . 1995;  24 42
    PubMedGoogle Scholar
  • 18 Songcharoen P. Brachial plexus injury in Thailand: a report of 520 cases.  Microsurgery . 1995;  16 35
    CrossrefPubMedGoogle Scholar
  • 19 Songcharoen P, Mahaisavariya B, Chotigavanich C. Spinal accessory neurotization for restoration of elbow flexion in avulsion injuries of the brachial plexus.  J Hand Surg . 1996;  21A 387
    PubMedGoogle Scholar
  • 20 Berman J, Anand P, Chen L. Pain relief from preganglionic injury to the brachial plexus by late intercostal nerve transfer.  J Bone Joint Surg . 1996;  78B 759
    PubMedGoogle Scholar
  • 21 Chuang D C, Lee G W, Hashem F, Wei F C. Restoration of shoulder abduction by nerve transfers in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers.  Plast Reconstr Surg . 1996;  96 122
    PubMedGoogle Scholar
  • 22 Chuang D C. Contralateral C7 transfer (CC-7T) for avulsion injury of the brachial plexus.  Tech Hand Upper Extrem Surg . 1999;  3 185
    PubMedGoogle Scholar
  • 23 Waikakul S, Orapin S, Vanadurongwan V. Clinical results of contralateral C7 root neurotization to the median nerve in brachial plexus injuries with total root avulsions.  J Hand Surg . 1999;  24B 556
    PubMedGoogle Scholar