ABSTRACT
The concept of reconstruction to regain lost function after brachial plexus lesions
has to be as broad and complex as possible. We have been exploring wider and more
novel clinical concepts at the Clinic of Plastic, Hand, and Reconstructive Surgery
at the Medical School of Hannover. Our ideas are supported by experience in 160 patients.
We have attempted to combine the use of a vascularized nerve graft and a micro-vascularly-transferred
autologous muscle.
Patients undergoing the procedures have included those with late complete root avulsions
and no functional return, as well as previously operated cases with poor recovery
of biceps, wrist, and forearm function.
The surgery is divided into two stages. In the first stage, the ulnar nerve is prepared
as a vascularized nerve graft and is sutured to intercostal nerves 3 to 5 or 6. In
stage 2, when the Tinel sign reaches the distal ends of the ulnar nerve graft (about
six to eight months later), the latissimus dorsi muscle is harvested. The muscle is
then placed as far distally as possible in the forearm and sutured to the deep finger
flexors and flexor pollicis longus. Proximally, the insertion is performed similarly
to Steindler's method. The vessels are connected to the brachial artery and vein and
the thoracodorsal nerve is sutured to the graft. This method provides flexion of both
the fingers and the elbow.
