Double Fascicular Transfer Using Partially Injured Donor Nerves: Is It Powerful Enough to Restore Elbow Flexion in Acute Brachial Plexus Injuries?

Abstract

Background Loss of elbow flexion is a common sequela of acute brachial plexus injuries (BPIs). The Mackinnon/Oberlin-II double fascicular transfer (DFT) is a widely used method to restore this function in acute C5–6 or C5–7 injuries. This study attempted to evaluate if this technique can be applied reliably for cases involving C8 and/or T1 injuries. Methods Adult patients with acute BPIs who underwent the Mackinnon/Oberlin-II DFT in our center between 2008 and 2018 were retrospectively identified. Group I (n = 37) included patients with only C5–6 or C5–7 injury, while group II (n = 32) patients presented C5–8 ± T1 injuries. The demographic data, pre- and postoperative neurologic evaluations, electrodiagnostic studies, and grip strength assessment were collected. Results A total of 69 patients met the inclusion criteria. Preoperatively, the patients in group II presented poorer nerve conduction and electromyography in both the median and the ulnar nerves and the supply muscles. The percentage of M3 achievement in both groups was 91.9 versus 87.5% and M4 was 73.0 and 71.9%, respectively, which both were not statically significant but the achievement of group II was slower than the group I, 1 to 2 months slower, respectively. Both groups had 57.57 and 46.0% of the postoperative grip power compared with the healthy side, the result of shoulder abduction was not different (p = 0.480). Conclusion With careful preoperative evaluation, early intervention, appropriate intraoperative functional fascicle selection, and aggressive postoperative rehabilitation, indications for the Mackinnon/Oberlin-II DFT technique can safely include acute C5–8 injuries and even partial T1 acute BPIs.

The Evolution of the Reconstructive Strategy for Elbow Flexion for Acute C5, C6 Brachial Plexus Injuries over Two Decades

“…Chang et al demonstrated the reliability of the Mackinnon method even when C8-T1 roots are injured and affect donor nerve quality. 19 The Mackinnon method could be an ideal surgical option in patients with BPI who present after 6 months.…”

Spinal accessory to suprascapular nerve transfer in brachial plexus injury: outcomes of anterior vs. posterior approach to the suprascapular nerve at associated ipsilateral spinal accessory nerve injury

“…The potential to utilize partially injured motor nerves as a donor in nerve transfer procedures is debatable [22,23]. A number of publications [22,23], of both experimental and clinical applications of partially injured nerves, have appeared. As of now, this methodology serves rather as a salvage procedure, and the outcomes have yet to be proven.…”

Traumatic brachial plexus injury: diagnosis and treatment

“…Elbow flexion can be restored with either transfer of a median nerve or median nerve fascicle to the biceps and brachialis motor branches of the MCN Figure 4a [27,28]. This can be performed either as a single or double fascicular transfer (DFT) [29] and is typically indicated for patients with C5–6 or C5–7 level injuries More recently, DFT in patients with C5–8 ± T1 injuries using partially injured donor nerves have demonstrated comparable recovery of elbow flexion strength but a slower time to recovery [30 ▪▪ ]. Elbow flexion can be reconstructed with transfer of the intercostal nerves to MCN.…”