Intercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions

Abstract

In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. The present study reports the results of both techniques from a single institution in a consecutive series of 42 patients between 1995 and 2008. From 1995 to 2000 we always used the intercostal nerve transfer, and from 2001 to 2008 both techniques were used. Biceps muscle force ≥ Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group (n = 25) and the intercostal nerve transfer group (n = 17).

Brachial Plexus Injury

“…In the reconstruction of elbow flexion in OBPP patients, transfer of either the MPN or the ICN to the MCN resulted in satisfactory function. 12 In adults, MPN-MCN transfer has yielded either equivocal or better results (92% satisfactory) when compared with ICN-MCN transfer (82% satisfactory) and has become the preferred method for either C5 to C6 or C5 to C7 injuries by some physicians. 12 This observation is likely due to the greater number of motor axons in the MCN when compared with the ICN.…”

“…12 In adults, MPN-MCN transfer has yielded either equivocal or better results (92% satisfactory) when compared with ICN-MCN transfer (82% satisfactory) and has become the preferred method for either C5 to C6 or C5 to C7 injuries by some physicians. 12 This observation is likely due to the greater number of motor axons in the MCN when compared with the ICN. In addition, it has been shown that the use of 3 ICNs produces better results than the use of only 2 nerves.…”

“…3). 12 In traction injury, the nerve is stretched but not torn from the spinal cord. The degree of injury may vary from mild forms where all neural structures are intact (neurapraxia) or disruption of only axons with intact supporting structures (axonotmesis) to a more severe form where the entire nerve along with all supporting layers is disrupted (neurotmesis).…”

“…12 For example, the transfer to proximal part of the musculocutaneous nerve (MCN), which contains mixed fibers, lowers the probability of successful reinnervation of elbow flexion as opposed to bicep branches of MCN, which consist purely of motor fibers. In addition, as the target muscle is closer to the site of nerve transfer, the recovery will be earlier and likely more successful.…”

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

“…At least two of them per recipient nerve are needed [24,124]. They have been used to re-innervate many nerves, like the AXN [89,92], MCN [24,105,106,[124][125][126], TLH [92,118,119], TDN [89,127] and SSN [90,91]. Their sensory branches can be used to recover some limb sensation, ameliorating the neuropathic pain.…”