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Use of long autologous nerve grafts in brachial plexus reconstruction: factors that affect the outcome

  • Clinical Article
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Abstract

Background

Using grafts directed to distal targets in brachial plexus reconstruction has the advantage over proximal targets of avoiding axonal dispersion. A long graft (more than 10 cm) is needed to reach most distal targets. The objective of this article is to identify factors associated with good versus poor outcomes in a clinical series of long grafts used for distal brachial plexus reconstruction.

Methods

In 34 patients with a flail arm, 47 sural grafts >10 cm long were followed for ≥2 years postoperatively. Surgical technique included standard supraclavicular exposure of the proximal brachial plexus and its branches, the phrenic nerve and spinal accessory nerve. Distal target nerves were exposed via an incision starting at the axilla, following the gap between the biceps and triceps. Cases achieving a good result were statistically compared against those with a poor result as to the donor nerve/root, target nerve, patient age and weight, time from trauma to surgery, graft length and long-term rehabilitation quality.

Findings

A good outcome was observed with 23 grafts (48.9%), but 66.7% of the 30 long grafts done within 6 months of trauma yielded a good result. Only 1 of 15 patients with the lowest quality rehabilitation score experienced a good result (6.6%) versus all 12 patients with the highest rating (p < 0.001). Trauma-to-surgery time was roughly half as long in those with a good result (4.7 vs. 9.0 months, p < 0.001). No other inter-group differences were observed.

Conclusions

The results of a series of distal brachial plexus target reinnervations with long grafts is presented and analyzed. According to them, time from trauma to surgery and an adequate postoperative rehabilitation are important predictors of outcome.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital de Clínicas University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, Buenos Aires, 1428, Argentina

    Mariano Socolovsky & Gilda Di Masi

  2. Department of Rehabilitation and Physiotherapy, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina

    Danilo Battaglia

Authors
  1. Mariano Socolovsky
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  2. Gilda Di Masi
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  3. Danilo Battaglia
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Corresponding author

Correspondence to Mariano Socolovsky.

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Comment

A very well prepared and undertaken analysis of the use of long course implants to allow re-inervation of functional muscle groups of the upper limb after injury or damage to the brachial plexus. The experimental design is good and the data analysed with appropriate techniques to allow the authors to draw clear conclusions that will contribute to discussion of surgical approaches for repair of the brachial plexus.

William Lowry Maxwell

Glasgow, UK

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Socolovsky, M., Di Masi, G. & Battaglia, D. Use of long autologous nerve grafts in brachial plexus reconstruction: factors that affect the outcome. Acta Neurochir 153, 2231–2240 (2011). https://doi.org/10.1007/s00701-011-1131-1

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  • DOI: https://doi.org/10.1007/s00701-011-1131-1

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