Neurotization for Elbow Flexion Restoration after Brachial Plexus Injury

Hamza, Fawzi A; Abdel Moktader, Magdy A; Ahmed, Reda M; ALTAMIMY, Hegazy M; Nassef, Mahmoud A; Eldosokey, Mahmoud A

doi:10.21608/ejprs.2020.68210

Neurotization for Elbow Flexion Restoration after Brachial Plexus Injury

Document Type : Original Article

Authors

¹ The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Al-Azhar University

² The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Al-Azhar university

³ The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Zagazig University

⁴ The Department of Rheumatology, Physical Medicine and Rehabilitation, Faculty of Medicine, Al-Azhar University

⁵ The Department of Plastic & Reconstructive Surgery, Al-Ahrar Teaching Hospital4, Cairo, Egypt

10.21608/ejprs.2020.68210

Abstract

Background: Restoration of elbow flexion after brachial
plexus injury has the first priority in adults. Nerve transfers
(neurotization) involves taking nerves with less important
functions or branches of a nerve that perform redundant
functions to restore important function in a more crucial nerve
that has been severely damaged. There are many described
neurotization methods for elbow flexion restoration like
Oberlin method, Double Fascicular Transfer (DFT) and Intercostal
Nerves (ICN) transfer. The aim of this study was to
evaluate different methods of nerve transfer for restoration
of elbow flexion after brachial plexus injury.
Patients and Methods: 21traumatic BPI were included in
this study (19 unilateral BPI and 1 bilateral BPI). 4 patients
were operated by Oberlin method, 5 by DFT and 12 by ICN
transfer.
Results: 3 primary procedures were used. Oberlin method
in 4 cases (19.0%) 3 cases (75%) give results M3 or more.
DFT method in 5 cases (23.8%) all of them give results M3
or more. ICN transfer in 12 cases (57.1%) 9 cases (75%) give
results M3 or more.
Conclusion: In upper BPI, DFT is the first option due to
effectiveness without noticeable donor functional affection
and Oberlin method is the 2nd option if median nerve has
functional deficit or not well recovered or has been used in
another transfer as in (c5, c6 and c7) cases. Three ICNs transfer
to musculocutaneous nerve without nerve graft in total BPI
is advisable due to effectiveness and least morbidity.

Keywords

Main Subjects

Hand and Upper Limb Surgery'

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