Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

• Published in: Surgical neurology international Vol. 11; p. 358
• Main Authors: Souza, Fernando Henrique, Bernardino, Silvya Nery, Junior, Auricelio Batista Cezar, Martins, Hugo André de Lima, Souza, Isabel Nery Bernardino, Souza, Regina Nery Bernardino, Azevedo-Filho, Hildo Rocha Cirne
• Format: Journal Article
• Language: English
• Published: United States Scientific Scholar 29.10.2020
• Subjects: Original; Peripheral nerve; Nerve transfer; Hand functional recovery; Brachial plexus; Musculocutaneous transfer
• ISSN: 2229-5097; 2152-7806; 2152-7806
• DOI: 10.25259/SNI_218_2019

Distal nerve transfers are an innovative modality for the treatment of C8-T1 brachial plexus lesions. The purpose of this case series is to report the authors' results with hand restoration function by nerve transfer in patients with lower brachial plexus injury. Three consecutive nerve transfers were performed in a series of 11 patients to restore hand function after injury to the lower brachial plexus: brachialis motor branch to anterior interosseous nerve (AIN) and supinator branch to the posterior interosseous nerve (PIN) in a first surgical procedure, and AIN to pronator quadratus branch of ulnar nerve between 4 and 6 months later. In all, 11 male patients underwent 33 surgical procedures. Time between brachial plexus injury and surgery was a mean of 11 months (range 4-13 months). Postoperative follow-up ranged from 12 to 24 months. We observed recovery of M3 or better finger flexion strength (AIN) and wrist extension (PIN) in 8 of the 11 surgically treated upper limbs. These patients recovered full thumb and finger extension between 6 and 12 months of surgery, without significant loss of donor function. Nerve transfers represent a way of restoring volitional control of upper extremity function in patients with C8-T1 brachial plexus injury.