Comparison of Nerve Transfers and Nerve Grafting for Traumatic Upper Plexus Palsy: A Systematic Review and Analysis

Garg, Rohit; Merrell, Gregory A.; Hillstrom, Howard J.; Wolfe, Scott W.

doi:10.2106/jbjs.i.01602

Cited by 216 publications

(157 citation statements)

References 131 publications

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“…Our approach to pooling data from multiple published reports is similar to that used by Garg et al 21 as well as Yang and associates, 83 although the model itself is somewhat different. Unlike those authors, we extended our analysis to include different nerve transfers and were able to show that partial ulnar transfer seemed to result in greater success in elbow flexion recovery than did graft repair.…”

Section: Discussionmentioning

confidence: 99%

Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Ali

Heuer

Faught

et al. 2015

JNS

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OBJECT Adult upper trunk brachial plexus injuries result in significant disability. Several surgical treatment strategies exist, including nerve grafting, nerve transfers, and a combination of both approaches. However, no existing data clearly indicate the most successful strategy for restoring elbow flexion and shoulder abduction in these patients. The authors reviewed the literature to compare outcomes of the three surgical repair techniques listed above to determine the optimal approach to traumatic injury to the upper brachial plexus in adults. METHODS Both PubMed and EMBASE databases were searched for English-language articles containing the MeSH topic “brachial plexus” in conjunction with the word “injury” or “trauma” in the title and “surgery” or “repair” as a MeSH subheading or in the title, excluding pediatric articles and those articles limited to avulsions. The search was also limited to articles published after 1990 and containing at least 10 operated cases involving upper brachial plexus injuries. The search was supplemented with articles obtained through the “Related Articles” feature on PubMed and the bibliographies of selected publications. From the articles was collected information on the operation performed, number of operated cases, mean subject ages, sex distribution, interval between injury and surgery, source of nerve transfers, mean duration of follow-up, year of publication, and percentage of operative success in terms of elbow flexion and shoulder abduction of the injured limb. The recovery of elbow flexion and shoulder abduction was separately analyzed. A subanalysis was also performed to assess the recovery of elbow flexion following various neurotization techniques. RESULTS As regards the restoration of elbow flexion, nerve grafting led to significantly better outcomes than either nerve transfer or the combined techniques (F = 4.71, p = 0.0097). However, separating the Oberlin procedure from other neurotization techniques revealed that the former was significantly more successful (F = 82.82, p < 0.001). Moreover, in comparing the Oberlin procedure to nerve grafting or combined procedures, again the former was significantly more successful than either of the latter two approaches (F = 53.14; p < 0.001). In the restoration of shoulder abduction, nerve transfer was significantly more successful than the combined procedure (p = 0.046), which in turn was significantly better than nerve grafting procedures (F = 5.53, p = 0.0044). CONCLUSIONS According to data in this study, in upper trunk brachial plexus injuries in adults, the Oberlin procedure and nerve transfers are the more successful approaches to restore elbow flexion and shoulder abduction, respectively, compared with nerve grafting or combined techniques. A prospective, randomized controlled trial would be necessary to fully elucidate differences in outcome among the various surgical approaches.

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Section: Discussionmentioning

confidence: 99%

Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Ali

Heuer

Faught

et al. 2015

JNS

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“…8 In adults with axillary nerve palsy, a single-surgeon series reported similar outcomes with nerve grafts and triceps to axillary nerve transfer. 23 Good outcomes following nerve grafting for treatment of isolated axillary nerve injury in adults have been reported.…”

Section: Discussionmentioning

confidence: 93%

“…In theory, this results in faster and better nerve recovery. 8 In addition, as many axillary nerve injuries occur in the quadrilateral space, nerve grafts of at least 8 cm in length are often required to bridge the gap.…”

mentioning

confidence: 99%

Triceps motor branch transfer for isolated traumatic pediatric axillary nerve injuries

Chim¹,

Kircher²,

Spinner

et al. 2015

PED

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OBJECT Transfer of the triceps motor branch has been used for treatment of isolated axillary nerve palsy in the adult population. However, there are no published data on the effectiveness of this procedure in the pediatric population with traumatic injuries. The authors reviewed demographics and outcomes in their series of pediatric patients who underwent this procedure. METHODS Six patients ranging in age from 10 to 17 years underwent triceps motor branch transfer for the treatment of isolated axillary nerve injuries between 4 and 8 months after the inciting injury. Deltoid muscle strength was evaluated using the modified British Medical Research Council (MRC) grading system. Shoulder abduction at last follow-up was measured. RESULTS The mean duration of follow-up was 38 months. The average postoperative MRC grading of deltoid muscle strength was 3.6 ± 1.3. The median MRC grade was 4. One patient who did not achieve an MRC grade of 3 suffered multiple injuries from high-velocity trauma. Unlike in the adult population, age, body mass index of the patient, and delay from injury to surgery were not significant factors affecting the outcome of the procedure. CONCLUSIONS In the pediatric population with traumatic injuries, isolated axillary nerve injury treated with triceps motor branch transfer can result in good outcomes.

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“…Shoulder abduction can be recovered with the double nerve transfer SAN branch for the trapezius to SSN together with TLH nerve to the AXN [45]. This dual shoulder transfers offer much better results than just one of them [17,30].…”

Section: Shoulder Nerve Transfersmentioning

confidence: 99%

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Vanaclocha‐Vanaclocha¹,

Ortiz-Criado²,

NievesSáiz-Sapena³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Successful re-innervation of proximal limb peripheral nerve injuries is rare. Axons regenerate at ~1 mm/day, reaching hand muscles by 24 months, finding them atrophied and fibrosed. Peripheral nerve injury repair is often delayed waiting for spontaneous recovery. This waiting time should not be longer than 6 months as after 18 months reinnervation will not achieve effective muscular function. When spontaneous recovery is impossible, referral too late or damage too severe, other options like a transfer from a nearby healthy nerve to the injured one must be considered. They are very successful, and the deficit in the donor site is usually minimal. The most common nerve transfers are a branch of the spinal nerve to the trapezius muscle to the suprascapular nerve, a branch of the long head of the triceps to the axillary nerve, a fascicle of the ulnar nerve to the motor branch of the biceps muscle, two branches of the median nerve to the posterior interosseous nerve and the anterior interosseous nerve to the ulnar nerve. There are many more options that can suit particular cases. Introduced in brachial plexus injury repair, they are now also applied to lower limb, to stroke and to some spinal cord injuries.

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Comparison of Nerve Transfers and Nerve Grafting for Traumatic Upper Plexus Palsy: A Systematic Review and Analysis

Cited by 216 publications

References 131 publications

Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Triceps motor branch transfer for isolated traumatic pediatric axillary nerve injuries

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

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