[Short-term efficacy of multiple nerves branch transfer for treating superior trunk brachial plexus in jury]

Jiuzhou Lu, Jianguang Xu, Wendong Xu, Lei Xu, Shihui Gu, Yundong Shen, Xin Zhao, Yudong Gu
Chinese Journal of Reparative and Reconstructive Surgery 2008, 22 (9): 1040-3

OBJECTIVE: To recover the loss of the shoulder and elbow function after superior trunks injury of brachial plexus through multiple nerves branch transfer simultaneously near the nerve entering points of recipient nerves.

METHODS: Four male patients (aged 21-39 years) with superior trunks injury of brachial plexus were treated from February to September 2007. All cases were injured in the traffic accident, left side in 1 case and right side in 3 cases, resulting in the loss of shoulder abduction, shoulder extorsion, shoulder lift and elbow flexion, and the increase of muscle strength of shoulder shrug, elbow extension and finger flexion to above or equal to 4th grade. Patients were hospitalized 3-11 months after injury. Electromyography showed that the functions of accessory nerve, ulnar nerve and the branch to long head of triceps brachii were good, but the function of median nerve was injured partially. The following multiple donor nerves transfer were performed under general anaesthesia, namely from posterior approach accessory nerve to suprascapular nerve, from triceps to axillary nerve, from the partial branch of ulnar nerve to the biceps and/or brachial is muscular branch of musculocutaneous nerve.

RESULTS: All incisions healed by first intention. One case suffered postoperative numbness on the ulnar side of hand and was symptomatically relieved after expectant treatment, while 3 cases had no manifestation of the motor and sensory functional injury related to donor nerve. All patients were followed up for 7-12 months. All patients regained the shoulder abduction and the elbow flexion 3-4 months after operation and electromyography showed that there was the regenerative potential in 3 recipient muscles. The shoulder abduction, elbow flexion and the muscle strength of the patients was 30-65 degrees, 90-120 degrees and 3-4 grade, respectively, 6-7 months after operation. Twelve months after operation, the first patient's shoulder abduction, external rotation, superinduction and elbow flexion almost returned to normal, and his shape of triangular muscle and biceps muscle were nearly normal.

CONCLUSION: Adopting donor nerves with similar functions to conduct the multiple donor nerves transfer in cord level has the advantages of little functional loss at the donor sites, and fast and sound functional recovery at the recipient sites. It is especially suitable for the superior trunks injury patient with delayed treatment and for the patient with the great risk in supraclavicular exploration, providing a new approach for treating superior trunks injury of brachial plexus.

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