Intercostal Nerve Neurotization for the Treatment of Obstetrical Brachial Plexus Palsy Patients

ABSTRACT

In severe obstetrical brachial plexus palsy with proximal nerve root involvement, there is an insufficient number of motor axons to reconstruct the entire plexus, and neurotization procedures are the only possibility to achieve useful upper extremity function. One of the most useful neurotization procedures is intercostal nerve transfer. In our practice, intercostal nerve transfer was used for direct neurotization of primary nerve targets or for neurotization of transferred muscles. The best results were seen after intercostal nerve transfer to musculocutaneous nerve and triceps branch. Unlike adult posttraumatic brachial plexus patients, neurotization of the ulnar and median nerves in obstetrical brachial plexus palsy patients will result in protective sensation in almost all patients, and if used early enough, postinjury active wrist and finger flexion is possible.

KEYWORDS

Obstetrical plexus palsy - nerve transfer - intercostal nerve neurotization

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