Elbow flexion reconstruction with nerve transfer or grafting in patients with brachial plexus injuries: A systematic review and comparison study

Abstract

IntroductionPosttraumatic brachial plexus (BP) palsy was used to be treated by reconstruction with nerve grafts. For the last two decades, nerve transfers have gained popularity and believed to be more effective than nerve grafting. The aim of this systematic review was to compare elbow flexion restoration with nerve transfers or nerve grafting after traumatic BP injury.MethodsPRISMA‐IPD structure was used for 52 studies included. Patients were allocated as C5‐C6 (n = 285), C5‐C6‐C7 (n = 150), and total BP injury (n = 245) groups. In each group, two treatment modalities were compared, and effects of age and preoperative interval were analyzed.ResultsIn C5‐C6 injuries, 93.1% of nerve transfer patients achieved elbow flexion force ≥M3, which was significantly better when compared to 69.2% of nerve graft patients (p < 0.001). For improved outcomes of nerve transfer patients, shorter preoperative interval was a significant factor in all injury patterns (p < 0.001 for C5‐C6 injuries and total BP injuries, p = 0.018 for C5‐C6‐C7 injuries), and young age was a significant factor in total BP injury pattern (p = 0.022).ConclusionsOur analyses showed that nerve transfers appear superior to nerve graftings especially in patients with a C5‐C6 injury. Unnecessary delays in surgery must be prevented, and younger patients may have more chance for better recovery.Level of evidenceLevel II.

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country

“…49,50 However, nerve grafting has several disadvantages, namely: donor site morbidity, the difficulties in determining the suitable root for grafting, non-viable nerve stumps, a longer route between the regenerating axon and denervated motor endplates. 46,48 Meanwhile, nerve transfer offers additional neurotization sources, suitable for BPI with root avulsion, facilitates regenerating axons closer to the denervated motor endplates (faster reinnervation), and no necessity for re-educating the muscle. Nevertheless, potential drawbacks include reduced function or co-contraction of the donor muscle.…”

Restoration of Elbow Flexion for Upper Trunk Brachial Plexus Injuries: Evaluation of Nerve Transfers and Modified Steindler Flexorplasty

“…Recent systematic reviews on nerve transfers showed that the Oberlin procedure had better outcomes than nerve grafting and other neurotization techniques. 4,8,[10][11][12][13]17 Steindler procedures, on the other hand, also had good outcomes, especially in cases where failed nerve surgery or in chronic cases where nerve surgery cannot be done. 14,15 Brunelli and Brunelli using the modified Steindler procedure published results of a 20-year retrospective study.…”

Lesiones del plexo braquial en adultos: Una revisión narrativa de la literatura

“…This combination results in rates of elbow flexion > or ¼ to M3 of 93.1% to 96% and 74% to 82.5% for shoulder abduction of > or ¼ to M3. 24,28,30,33,34 2) Lower trunk injuries (C8-T1): the functional outcomes in the hand are significantly less successful compared with those in the shoulder and elbow, because hand recovery is more complex. The treatment aims to restore a functional grip and fist either with nerve or tendon transfers.…”

“…Los resultados de estas cirugías han demostrado superioridad en comparación con los de la reconstrucción con injerto para reanimar la flexión del codo. 24,[28][29][30] Las transferencias nerviosas más utilizadas incluyen la de Oberlin, en la que un fascículo del nervio ulnar al músculo flexor ulnar del carpo se usa para reinervar el músculo bíceps braquial, transfiriéndolo a la rama del bíceps que proviene del nervio musculocutaneo. 31 Otra transferencia frecuentemente utilizada en lesiones del tronco superior es la de Leechavengvongs, en la que se usan ramas del nervio radial a una de las cabezas del músculo tríceps para reinervar el deltoides.…”