Double Fascicular Transfer Using Partially Injured Donor Nerves: Is It Powerful Enough to Restore Elbow Flexion in Acute Brachial Plexus Injuries?

Tommy Nai-Jen Chang; Johnny Chuieng-Yi Lu; Che-Hsiung Lee; Yu-Ching Lin; Yenpo Lin; Nicole A. Zelenski; Jennifer An-Jou Lin; Abraham Zavala; Cheyenne Wei-Hsuan Sung; Lisa Wen-Yu Chen; David Chwei-Chin Chuang

doi:10.1055/s-0041-1736320

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2023; 39(04): 272-278
DOI: 10.1055/s-0041-1736320

Original Article

Double Fascicular Transfer Using Partially Injured Donor Nerves: Is It Powerful Enough to Restore Elbow Flexion in Acute Brachial Plexus Injuries?

Tommy Nai-Jen Chang

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

,

Johnny Chuieng-Yi Lu

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

,

Che-Hsiung Lee

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

,

Yu-Ching Lin

²Department of Medical Imaging and Intervention, Chang Gung Memorial, Hospital at Keelung, Chang Gung University, Taoyuan, Taiwan

,

Yenpo Lin

³Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

,

Nicole A. Zelenski

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

⁴Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia

,

Jennifer An-Jou Lin

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

,

Abraham Zavala

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

⁵Department of Plastic and Reconstructive Surgery, Instituto Nacional de Salud del Niño - San Borja, Lima, Peru

,

Cheyenne Wei-Hsuan Sung

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

,

Lisa Wen-Yu Chen

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

,

David Chwei-Chin Chuang

¹Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan

› Author Affiliations

Abstract

Background Loss of elbow flexion is a common sequela of acute brachial plexus injuries (BPIs). The Mackinnon/Oberlin-II double fascicular transfer (DFT) is a widely used method to restore this function in acute C5–6 or C5–7 injuries. This study attempted to evaluate if this technique can be applied reliably for cases involving C8 and/or T1 injuries.

Methods Adult patients with acute BPIs who underwent the Mackinnon/Oberlin-II DFT in our center between 2008 and 2018 were retrospectively identified. Group I (n = 37) included patients with only C5–6 or C5–7 injury, while group II (n = 32) patients presented C5–8 ± T1 injuries. The demographic data, pre- and postoperative neurologic evaluations, electrodiagnostic studies, and grip strength assessment were collected.

Results A total of 69 patients met the inclusion criteria. Preoperatively, the patients in group II presented poorer nerve conduction and electromyography in both the median and the ulnar nerves and the supply muscles. The percentage of M3 achievement in both groups was 91.9 versus 87.5% and M4 was 73.0 and 71.9%, respectively, which both were not statically significant but the achievement of group II was slower than the group I, 1 to 2 months slower, respectively. Both groups had 57.57 and 46.0% of the postoperative grip power compared with the healthy side, the result of shoulder abduction was not different (p = 0.480).

Conclusion With careful preoperative evaluation, early intervention, appropriate intraoperative functional fascicle selection, and aggressive postoperative rehabilitation, indications for the Mackinnon/Oberlin-II DFT technique can safely include acute C5–8 injuries and even partial T1 acute BPIs.

Keywords

the Mackinnon/Oberlin-II double fascicular transfer - partially injured donor nerve - magnetic resonance imaging

Full Text

References

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