J Hand Microsurg 2011; 03(01): 6-10
DOI: 10.1007/s12593-011-0031-1
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Nerve Transfers for Traumatic Brachial Plexus Injury: Advantages and Problems

Tim Hems

Subject Editor:
Further Information

Publication History

13 October 2010

12 December 2010

Publication Date:
05 September 2016 (online)

Abstract

In recent years nerve transfers have been increasingly used to broaden reconstructive options for brachial plexus reconstruction. Nerve transfer is a procedure where an expendable nerve is connected to a more important nerve in order to reinnervate that nerve. This article outlines the experience of the Scottish National Brachial Plexus Injury Service as our use of nerve transfers has increased. Outcomes have improved for reconstruction of the paralysed shoulder using transfer of the accessory nerve to the suprascapular nerve. Medial pectoral to musculocutaneous nerve transfer has proved reliable for restoration of elbow flexion for patients with C5,6 and C5,6,7 injuries. Problems with nerve transfers include morbidity in the donor nerve territory, co-contraction, and pre-existing injury to the donor nerve. There is a balance of risks in these procedures which should be weighed up in individual cases.

 
  • References

  • 1 Lurje A. Concerning surgical treatment of traumatic inury of the upper division of the brachial plexus (Erb’s-type). Ann Surg 1948; 127: 317-326
  • 2 Seddon HJ. Nerve grafting. J Bone Joint Surg Br 1963; 45B: 447-461
  • 3 Leechavengvongs S, Witoonchart K, Uerpairojkit C et al Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, Part II: a report of 7 cases. J Hand Surg [Am] 2003; 28A: 633-638
  • 4 Oberlin C, Beal D, Leechavengvongs S et al Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsionof the brachial plexus: anatomical study and report of four cases. J Hand Surg [Am] 1994; 19: 232-237
  • 5 Brandt K, MacKinnon S. A technique for maximising biceps recovery in brachial plexus reconstruction. J Hand Surg [Am] 1993; 18A: 726-733
  • 6 Novak CB, Mackinnon SE, Tung TH. Patient outcome following a thoracodorsal to musculocutaneous nerve transfer for reconstruction of elbow flexion. Br J Plast Surg 2002; 55: 416-419
  • 7 Gu Y-D, Wu MM, Zhen YL. Phrenic nerve transfer for brachial plexus notor neurotisation. Microsurgery 1989; 10: 287-289
  • 8 Gu Y-D, Ma M-K. Use of the phrenic nerve for brachial plexus reconstruction. Clin Orthop 1996; 323: 119-121
  • 9 Gu Y-D, Zhang GM, Chen DS et al Seventh cervical nerve root transfer from the contralateral side for treatment of brachial plexus root avulsions. J Hand Surg [Br] 1992; 17B: 518-521
  • 10 Birch R, Bonney G. Traumatic lesions of the brachial plexus. 1998. In: Birch R, Bonney G, Wynn Parry CB. (eds) Surgical disorders of the peripheral nerves. Churchill Livingstone; Edinburgh: pp 157-207
  • 11 Terzis JK, Kostas I. Suprascapular nerve reconstruction in 118 cases of adult posttraumatic brachial plexus. Plast Recon Surg 2006; 117: 617-629
  • 12 Chan P, Hems TEJ. Clinical signs of accessory nerve palsy. J Trauma-Injury Infection & Critical Care 2006; 60: 1142-1144
  • 13 Teboul F, Kakkar R, Ameur N et al Transfer of fascicles from the ulnar nerve to the biceps in the treatment of upper brachial plexus palsy. J Bone Joint Surg Am 2004; 86: 1485-1490