Ventilation and Exercise Performance After Phrenic Nerve and Multiple Intercostal Nerve Transfers for Avulsed Brachial Plexus Injury

Intercostal nerve transfer is a well-established technique in the treatment of some severe brachial plexus lesions in adults. There is, however, concern that in the presence of an ipsilateral phrenic nerve palsy it may lead to a significant compromise of respiratory function. 20 patients having intercostal nerve transfers had their lung function assessed pre-operatively and 6 weeks postoperatively. The patients were subsequently questioned about symptoms of respiratory dysfunction. There was no evidence that intercostal nerve transfer leads to a significant reduction in respiratory function in adults. It therefore appears safe to perform intercostal nerve transfers in adults following brachial plexus injuries even in the presence of an ipsilateral phrenic nerve palsy.

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Comparative Study of Phrenic and Intercostal Nerve Transfers for Elbow Flexion After Global Brachial Plexus Injury

Hand ◽

10.1177/1558944716660555qq ◽

2016 ◽

Vol 11 (1_suppl) ◽

pp. 21S-22S

Author(s):

Yuzhou Liu ◽

Jie Lao ◽

Xin Zhao ◽

Kaiming Gao

Keyword(s):

Comparative Study ◽

Brachial Plexus ◽

Brachial Plexus Injury ◽

Elbow Flexion ◽

Intercostal Nerve ◽

Nerve Transfers

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Investigation Into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Reinnervation: A Systematic Review

Hand ◽

10.1177/1558944717744280 ◽

2017 ◽

Vol 13 (6) ◽

pp. 621-626 ◽

Cited By ~ 2

Author(s):

Hyuma A. Leland ◽

Beina Azadgoli ◽

Daniel J. Gould ◽

Mitchel Seruya

Keyword(s):

Systematic Review ◽

Brachial Plexus ◽

Donor Site ◽

Elbow Flexion ◽

Donor Site Morbidity ◽

Intercostal Nerve ◽

Optimal Number ◽

Musculocutaneous Nerve ◽

Nerve Transfers ◽

Meta Analyses

Background: The purpose of this study was to systematically review outcomes following intercostal nerve (ICN) transfer for restoration of elbow flexion, with a focus on identifying the optimal number of nerve transfers. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies describing ICN transfers to the musculocutaneous nerve (MCN) for traumatic brachial plexus injuries in patients 16 years or older. Demographics were recorded, including age, time to operation, and level of brachial plexus injury. Muscle strength was scored based upon the British Medical Research Council scale. Results: Twelve studies met inclusion criteria for a total of 196 patients. Either 2 (n = 113), 3 (n = 69), or 4 (n = 11) ICNs were transferred to the MCN in each patient. The groups were similar with regard to patient demographics. Elbow flexion ≥M3 was achieved in 71.3% (95% confidence interval [CI], 61.1%-79.7%) of patients with 2 ICNs, 67.7% (95% CI, 55.3%-78.0%) of patients with 3 ICNs, and 77.0% (95% CI, 44.9%-93.2%) of patients with 4 ICNs ( P = .79). Elbow flexion ≥M4 was achieved in 51.1% (95% CI, 37.4%-64.6%) of patients with 2 ICNs, 42.1% (95% CI, 29.5%-55.9%) of patients with 3 ICNs, and 48.4% (95% CI, 19.2%-78.8%) of patients with 4 ICNs ( P = .66). Conclusions: Previous reports have described 2.5 times increased morbidity with each additional ICN harvest. Based on the equivalent strength of elbow flexion irrespective of the number of nerves transferred, 2 ICNs are recommended to the MCN to avoid further donor-site morbidity.

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Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000003668 ◽

2017 ◽

Vol 140 (4) ◽

pp. 747-756 ◽

Cited By ~ 10

Author(s):

Kathleen M. O’Grady ◽

Hollie A. Power ◽

Jaret L. Olson ◽

Michael J. Morhart ◽

A. Robertson Harrop ◽

...

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Nerve Graft ◽

Nerve Transfers ◽

Obstetric Brachial Plexus ◽

Graft Reconstruction ◽

Obstetric Brachial Plexus Injury

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Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction

Journal of Neurosurgery ◽

10.3171/jns.2004.101.5.0770 ◽

2004 ◽

Vol 101 (5) ◽

pp. 770-778 ◽

Cited By ~ 38

Author(s):

Jayme Augusto Bertelli ◽

Marcos Flávio Ghizoni

Keyword(s):

Brachial Plexus ◽

Ulnar Nerve ◽

Phrenic Nerve ◽

Cranial Nerve ◽

External Rotation ◽

Elbow Flexion ◽

Content Type ◽

Nerve Transfers ◽

Contralateral Motor ◽

Fine Print

Object. The goal of this study was to evaluate outcomes in patients with brachial plexus avulsion injuries who underwent contralateral motor rootlet and ipsilateral nerve transfers to reconstruct shoulder abduction/external rotation and elbow flexion. Methods. Within 6 months after the injury, 24 patients with a mean age of 21 years underwent surgery in which the contralateral C-7 motor rootlet was transferred to the suprascapular nerve by using sural nerve grafts. The biceps motor branch or the musculocutaneous nerve was repaired either by an ulnar nerve fascicular transfer or by transfer of the 11th cranial nerve or the phrenic nerve. The mean recovery in abduction was 90° and 92° in external rotation. In cases of total palsy, only two patients recovered external rotation and in those cases mean external rotation was 70°. Elbow flexion was achieved in all cases. In cases of ulnar nerve transfer, the muscle scores were M5 in one patient, M4 in six patients, and M3+ in five patients. Elbow flexion repair involving the use of the 11th cranial nerve resulted in a score of M3+ in five patients and M4 in two patients. After surgery involving the phrenic nerve, two patients received a score of M3+ and two a score of M4. Results were clearly better in patients with partial lesions and in those who were shorter than 170 cm (p < 0.01). The length of the graft used in motor rootlet transfers affected only the recovery of external rotation. There was no permanent injury at the donor sites. Conclusions. Motor rootlet transfer represents a reliable and potent neurotizer that allows the reconstruction of abduction and external rotation in partial injuries.

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Elbow flexion strength and contractile activity after partial ulnar nerve or intercostal nerve transfers for brachial plexus injuries

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420922184 ◽

2020 ◽

Vol 45 (8) ◽

pp. 818-826

Author(s):

Dawn Sinn Yii Chia ◽

Kazuteru Doi ◽

Yasunori Hattori ◽

Sotetsu Sakamoto

Keyword(s):

Brachial Plexus ◽

Ulnar Nerve ◽

Muscle Power ◽

Contractile Activity ◽

Nerve Transfer ◽

Elbow Flexion ◽

Intercostal Nerve ◽

Nerve Transfers ◽

Forearm Muscles ◽

Flexion Strength

We compared the outcomes of 23 partial ulnar nerve and 15 intercostal nerve transfers for elbow flexion reconstruction in patients with C56 or C567 brachial plexus injuries using manual muscle power, dynamometric measurements of elbow flexion strength and electromyography. The range of elbow flexion and muscle strength recovery to Grade 3 or 4 were comparable between the two groups. The patients with C567 injuries had significantly stronger eccentric contraction after the partial ulnar nerve transfer than after the intercostal nerve transfer ( p < 0.05). Electromyography of individual muscles demonstrated that the patients with partial ulnar nerve transfers were unable to voluntarily isolate biceps contraction and recruited forearm flexors and extensors. The patients after partial ulnar nerve transfer had significantly more activity of the forearm muscles during concentric elbow flexion than after intercostal nerve transfers ( p < 0.05). We conclude that partial ulnar nerve transfers were superior to intercostal nerve transfers when assessed quantitatively with the dynamometer to evaluate elbow flexion, although simultaneous recruitment of forearm muscles may have contributed to the increased elbow flexion strength in the patients with the partial ulnar nerve transfer. Level of evidence: III

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