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J Reconstr Microsurg 2016; 32(07): 546-550
DOI: 10.1055/s-0036-1583302
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Phrenic Nerve Transfer for Reconstruction of Elbow Extension in Severe Brachial Plexus Injuries

Leandro P. Flores
1   Department of Neurosurgery, Hospital das Forças Armadas, Brasília, Distrito Federal, Brazil
,
Mariano Socolovsky
2   Peripheral Nerve and Brachial Plexus Surgery Unit, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History

19 January 2016

15 March 2016

Publication Date:
04 May 2016 (online)

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Abstract

Background Restoring elbow extension is an important objective to pursue when repairing the brachial plexus in patients with a flail arm. Based upon the good results obtained using the phrenic nerve to restore elbow flexion and shoulder stability, we hypothesized that this nerve could also be employed to reconstruct elbow extension in patients with severe brachial plexus injuries.

Methods A retrospective study of 10 patients in which the phrenic nerve targeted the radial nerve (7 patients) or the branch to the long head of the triceps (3 patients) as a surgical strategy for reconstruction of the brachial plexus.

Results The mean postoperative follow-up time was 34 months. At final follow-up, elbow extension graded as M4 was measured in three patients, Medical Research Council MRC M3 in five patients, and M2 in one patient, while one patient experienced no measurable recovery (M0). No patient complained or demonstrated any signs of respiratory insufficiency postoperatively.

Conclusions The phrenic nerve is a reliable donor for reanimation of elbow extension in such cases, and the branch to the long head of the triceps should be considered as a better target for the nerve transfer.

Keywords

brachial plexus - elbow extension - microsurgery - triceps palsy
 

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