HSS Journal

, Volume 3, Issue 1, pp 77–82 | Cite as

Nerve Transfers for Adult Traumatic Brachial Plexus Palsy (Brachial Plexus Nerve Transfer)

Original Article

Abstract

Adult traumatic brachial plexus injuries can have devastating effects on upper extremity function. Although neurolysis, nerve repair, and nerve grafting have been used to treat injuries to the plexus, nerve transfer makes use of an undamaged nerve to supply motor input over a relatively short distance to reinnervate a denervated muscle. A review of several recent innovations in nerve transfer surgery for brachial plexus injuries is illustrated with surgical cases performed at this institution.

Key words

adult brachial plexus nerve transfer microsurgery nerve repair 

References

  1. 1.
    Narakas A (1981) Brachial plexus surgery. Orthop Clin North Am 12(2):303–323PubMedGoogle Scholar
  2. 2.
    Kline DG, Tiel RL (2005) Direct plexus repair by grafts supplemented by nerve transfers. Hand Clin 21:55–69PubMedCrossRefGoogle Scholar
  3. 3.
    Brophy RH, Wolfe SW (2005) Planning brachial plexus surgery: treatment options and priorities. Hand Clin 21(1):47–54PubMedCrossRefGoogle Scholar
  4. 4.
    Bentolila V, Nizard R, Bizot P, et al. (1999) Complete traumatic brachial plexus palsy: Treatment and outcome after repair. J Bone Jt Surg 81-A(1):20–28Google Scholar
  5. 5.
    Samii M, Carvalho GA, Nikkhah G, et al. (1997) Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries. J Neurosurg 87(6):881–886PubMedCrossRefGoogle Scholar
  6. 6.
    Chuang DC, Epstein MD, Yeh MC, et al. (1993) Functional restoration of elbow flexion in brachial plexus injuries: Results in 167 patients (excluding obstetric brachial plexus injury). J Hand Surg 18A(2):285–291Google Scholar
  7. 7.
    Hentz VR, Narakas A (1988) The results of microneurosurgical reconstruction in complete brachial plexus palsy: Assessing outcome and predicting results. Orthop Clin North Am 19(1):107–114PubMedGoogle Scholar
  8. 8.
    Songcharoen P, Wongtrakul S, Spinner RJ (2005) Brachial plexus injuries in the adult. Nerve transfers: The Siriraj Hospital experience. Hand Clin 21:83–89PubMedCrossRefGoogle Scholar
  9. 9.
    Merrell GA, Barrie KA, Katz DL, et al. (2001) Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg 26A:303–314Google Scholar
  10. 10.
    Merrell GA, Wolfe SW (2002) Adult brachial plexus and thoracic outlet surgery. Tech Should Elb Surg 3(4):271–281CrossRefGoogle Scholar
  11. 11.
    Birch R, Bonney G, Wynn Parry CB (1998) Traumatic lesions of the brachial plexus. In: Surgical disorders of the peripheral nerves. Churchill Livingstone, Hong Kong, pp 175–177Google Scholar
  12. 12.
    Narakas AO, Hentz VR (1988) Neurotization in brachial plexus injuries: Indications and results. Clin Orthop Relat Res 237:43–56PubMedGoogle Scholar
  13. 13.
    Bertelli JA, Ghizoni MF (2004) Reconstruction of C5 and C6 brachial plexus avulsion injury by multiple nerve transfers: Spinal accessory to suprascapular, ulnar fascicles to biceps branch, and triceps long or lateral head branch to axillary nerve. J Hand Surg [Am] 29(1):131–139CrossRefGoogle Scholar
  14. 14.
    Witoonchart K, Leechavengvongs S, Uerpairojkit C, et al. (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: An anatomic feasibility study. J Hand Surg 28A:628–632Google Scholar
  15. 15.
    Hallock GG (1993) The triceps muscle flap for axillary contracture release. Ann Plast Surg 30:359–362PubMedCrossRefGoogle Scholar
  16. 16.
    Lim AYT, Pereira BP, Kumar, VP (2001) The long head of the triceps brachhii as a free functioning muscle transfer. Plast Reconstr Surg 107:1746–1752PubMedCrossRefGoogle Scholar
  17. 17.
    OberlinC, Beal D, Leechavengvongs S, et al. (1994) Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: Anatomical study and report of four cases. J Hand Surg 19A(2):232–237Google Scholar
  18. 18.
    Nagano A, Tsuyama N, Ochiai N, et al. (1989) Direct nerve crossing with the intercostals nerve to treat avulsion injuries of the brachial plexus. J Hand Surg 14A(6):980–985Google Scholar
  19. 19.
    Mackinnon SE, Novak CB, Myckatyn TM, et al. (2005) Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. J Hand Surg [Am] 30(5):978–985CrossRefGoogle Scholar
  20. 20.
    Brandt KE, Mackinnon SE (1993) A technique for maximizing biceps recovery in brachial plexus reconstruction. J Hand Surg 18A:726–733Google Scholar
  21. 21.
    Mackinnon SE, Dellon AL (1991) Surgery of the peripheral nerve. Thieme Medical Publishers, New York, pp 423–454Google Scholar
  22. 22.
    Chuang DCC, Yeh MC, Wei FC (1992) Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries—evaluation of 66 patients. J Hand Surg 17A:822–828Google Scholar
  23. 23.
    Chuang DC (2005) Nerve transfers in adult brachial plexus injuries: My methods. Hand Clin 21:71–82PubMedCrossRefGoogle Scholar
  24. 24.
    Leechavengvongs S, Witoonchart K, Uerpairojkit C, et al. (1998) Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): A report of 32 cases. J Hand Surg 23A(4):711–716Google Scholar
  25. 25.
    Teboul F, Kakkar R, Ameur N, et al. (2004) Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy. J Bone Jt Surg 86-A(7):1485–1490Google Scholar
  26. 26.
    Sungpet A, Suphachatwong C, Kawinwonggowit V, et al. (2000) Transfer of a single fascicle from the ulnar nerve to the biceps muscle after avulsions of upper roots of the brachial plexus. J Hand Surg 25B(4):325–328Google Scholar
  27. 27.
    Leechavengvongs S, Witoonchart K, Uerpairojkit C, et al. (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: A report of 7 cases. J Hand Surg 28A:633–638Google Scholar
  28. 28.
    Doi K, Sakai K, Kuwata N, et al. (1995) Double-muscle technique for reconstruction of prehension after complete avulsion of brachial plexus. J Hand Surg [Am] 20:408CrossRefGoogle Scholar
  29. 29.
    Barrie KA, Steinmann SP, Shin AY, et al. (2004) Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion. Neurosurg Focus 16(5):E8PubMedCrossRefGoogle Scholar

Copyright information

© Springer Verlag 2006

Authors and Affiliations

  1. 1.Center for Hand and Upper Extremity SurgeryHospital for Special SurgeryNew YorkUSA

Personalised recommendations