Free muscle transfer can restore hand function after injuries of the lower brachial plexus

Abstract

One pattern of injury to the brachial plexus shows recovery of the fifth and sixth cervical nerves but little else. These patients have useful shoulders and functional elbow flexion, but elbow and wrist extension is weak or absent. Their hand function is negligible. We restored hand function in three such patients using free functioning muscle transfer for finger flexion and transfer of the sensory rami of the intercostal nerve to the ulnar nerve for sensation. Supplementary operations to restore elbow and wrist extension were necessary in one patient.

Finger movement at birth in brachial plexus birth palsy

“…Other investigators have reported that some OBPI patients achieved voluntary finger movement with double free-muscle transfer [38] . Our present study is unique in that it evaluates the relationship between finger movement at birth, and the outcome of the primary and secondary surgeries in OBPI patients.…”

“…However, there are only few reports correlating finger movements and obstetric brachial plexus injury [2,38] and hand injuries, despite the hands are important in performing daily activities [36] . Finger movement at birth was evaluated as one of the potential risk factors for permanent injury and predictors of future osseous shoulder deformity [2] .…”

Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

“…In late brachial plexus cases, when native muscle targets have been wasted, free muscle transfer innervated by intercostal nerves seem to be a viable procedure [16,18,[35][36][37][38][39] . When planning a muscle transfer for upper extremity reanimation, in order to obtain the maximum result it is imperative to choose the correct muscle for needed function.…”

Restoration of hand function in C7–T1 brachial plexus palsies using a staged approach with nerve and tendon transfer

“…Therefore, some authors prefer tendon transfer, 1,2 free muscle transfer, 3 or extensor tenodesis techniques, 5 but the limited choice of available muscles in the forearm determines the limited recovery after these procedures. Extraplexal neurotizations, such as those involving the multi-intercostal nerve or the contralateral C-7 nerve, were not effective in finger extension either.…”