Morbidity of Nerve Transfers for Brachial Plexus Birth Injury: A Systematic Review

Abstract

Background: The purpose of this article is to systematically review the peer-reviewed literature on the morbidity of nerve transfers performed in patients with brachial plexus birth injury (BPBI). Nerve transfers for restoration of function in patients with BPBI that fail nonoperative management are increasing in popularity. However, relatively little attention has been paid to the morbidity of these transfers in the growing patient. The authors systematically review the current literature regarding donor site morbidity following nerve transfer for BPBI. Methods: A systematic review of the Medline and EMBASE databases was conducted through February 2020. Primary research articles written in English and reporting donor site morbidity after nerve transfer for BPBI were included for review. Results: Thirty-six articles met inclusion criteria, all of which were retrospective reviews or case reports. There was great heterogeneity in outcomes assessed. With 5 year or less follow-up, all transfers were relatively well tolerated with the exception of the hypoglossal nerve transfer. Conclusion: Nerve transfers are a well-recognized treatment strategy for patients with BPBI and have an acceptable risk profile in the short term. Full hypoglossal nerve transfers for BPBI are of historical interest. Donor site morbidity is grossly underreported. This review highlights the need for more objective and systematic reporting of donor site outcomes, and the need for longer term follow-up in these patients. Level of Evidence: Systematic review. Level III—therapeutic.

Brachial plexus birth injury: advances and controversies

“…The second condition to justify sacrificing intact nerves is that limb functionality is not decreased by doing so. In this respect, the literature on reported donor nerve complications for BPBI has been summarized in a recent systematic literature review (Hinchcliff et al., 2021). At first glance, it seems that nerve transfers are safe to use, as severe complications were not noted.…”

Recent Advances in the Treatment of Brachial Plexus Birth Injury

“…45 Unlike nerve graft reconstruction, partial cutaneous sensory recovery is not expected after distal nerve transfers of motor donors and recipients, and donor nerve morbidity with functional downgrade is always a potential risk. 53,85,86 Finally, as motor recovery following cervical root nerve grafting may not be complete until 4 years of age, it remains to be shown whether the final outcomes of distal nerve transfers are equivalent to or surpass those of nerve grafting. 87 Based on these considerations, current indications for distal nerve transfers in BPBI are outlined in Table 6.…”

Brachial Plexus Birth Injuries

“…Furthermore, it is rare for a study to compare multiple treatment strategies for a set of patients with a common pathology 59 . Additionally, authors frequently fail to report any donor site morbidity associated with nerve transfers in a standard fashion, although the potential effect of denervation on musculoskeletal growth is acknowledged 60 . In a report by the International Federation of Societies for Surgery of the Hand, the committee recommended that surgeons who treat BPBI be both able and willing to include brachial plexus exploration and nerve reconstruction as part of their treatment algorithm and not overly rely on nerve transfers alone 74 .…”

“…However, when comparing nerve reconstruction techniques performed in patients after 9 months of age, Daly et al found no difference between nerve grafting and nerve transfers 42 . Additionally, the exclusive use of nerve transfers in brachial plexus reconstruction may waste otherwise viable donor axons from intact nerve roots, is associated with potential donor site morbidity 60 , and ignores sensory innervation.…”