Free muscle transplantation combined with intercostal nerve crossing for reconstruction of elbow flexion and wrist extension in brachial plexus injuries

Abstract

Complete paralysis due to traumatic brachial plexus injury is extremely difficult to treat when the injury affects whole nerve roots and when motor function fails to show any signs of recovery. Seddon has suggested that arthrodesis of the shoulder and amputation at the humerus, combined with the use of a functional upper extremity prosthesis, was the most practical procedure available. Since 1965, in cases of irreparable lesions such as complete root avulsion type injuries, we have performed direct intercostal nerve crossing to the musculocutaneous nerve without free nerve graft to achieve elbow flexion. However, it is necessary to operate on the patient within 6 months following the injury to obtain good results. In the past there was no procedure for dealing with delayed cases of complete brachial plexus palsy. However, with the advent of microsurgical techniques, new approaches have become open to us. Since 1978, we have reconstructed the elbow flexor by the combined surgery of free muscle transplantation with intercostal nerve crossing in delayed cases of complete paralysis. This article introduces the operative technique and the results we have obtained.

Shoulder fusion and free‐functioning gracilis transplantation in patients with elbow and shoulder paralysis caused by poliomyelitis

“…3 Akasaka et al reported successful restoration of elbow¯exion using rectus femoris innervated by the intercostal nerves. 4 In our series, all cases recovered grade 3 or more elbow¯exion, and were able to place their hands to their mouths.…”

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

“…Subsequently, several authors have reported their experience with intercostal nerve transfer [4,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] . In order to restore maximum function of the arm, as many intercostal nerves as possible are harvested and transferred.…”

“…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.…”

Trizeps-Bizeps-Transposition zur Wiederherstellung der Ellenbogenbeugung bei Muskellähmungen

“…Zur Wiedererlangung der Ellenbogenbeugung sind Transpositionen des Musculus latissimus dorsi [13,17] und des Musculus pectoralis major [12,18], die Versetzung der Handflexoren nach Steindler [20] oder Handextensoren nach Lange [14] sowie freie Transplantationen nicht ortsst~indiger Muskeln [1] angegeben worden.…”