Reconstruction of a C7-T1 brachial plexus lower root injury by transferring multiple nerves and a free gracilis muscle: Case report

Francisco Soldado, Marcos F Ghizoni, Jayme Bertelli
Microsurgery 2020 March 18
32187408
Lower-type brachial plexus injuries (BPI) are uncommon, and traditional reconstruction with tendon transfer procedures generally produce mediocre results. However, the advent of nerve transfers has rejuvenated the reconstructive options for peripheral nerve and spinal cord injuries. In this paper, we report the case 32 year-old patient with a C7-T1 avulsion BPI in whom multiple motor and sensory nerve transfers, combined with a free gracilis muscle flap transfer, were used to restore upper-limb functional defects. Five months after injury, several nerves were transferred (posterior division of the axillary nerve to motor nerve branches of the triceps, extensor carpi radialis brevis to flexor pollicis longus, supinator to the posterior interosseous nerve, brachialis to the ulnar nerve, and a cutaneous branch to the palm of the median nerve to the ulnar proper palmar digital nerve of the little finger). No complications occurred. M4 strength elbow extension, complete active finger extension and ulnar protective sensation were obtained. However, unsuccessful finger flexion reconstruction required a free gracilis muscle flap transfer motorized by the distal branch of the pronator teres, performed 43 months after the first surgery and resulting in complete finger flexion. Multiple nerve transfers might be a valid strategy for reconstructing lower BPIs, either in their early or late stage, which might be combined with a free gracilis muscle flap transfer.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
32187408
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"