Operations to restore elbow flexion after brachial plexus injuries

Abstract

We have reviewed 50 patients at a mean period of 2.7 years after operations to restore elbow flexion lost as a result of traction injuries of the brachial plexus. A variety of operations were used and, in general, patient satisfaction was high. Objectively, however, the power in the transferred muscles was poor; less than half of the patients had a significant improvement in function. Poor control of the shoulder often compromised the result. Latissimus dorsi and triceps transfers proved most reliable, and some Steindler flexorplasties also gave satisfactory results. Pectoralis major transfers were disappointing and we do not recommend their use in women.

Bipolar latissimus transfer for restoration of elbow flexion

“…26 Latissimus transfers generally result in high patient satisfaction despite poor power, often worsened by concomitant instability of the shoulder in brachial plexus palsies. 28 Though a stable shoulder is not a prerequisite for transfer, 29 the synergistic effect of adjacent joint stability is consistent with the finding that after the shoulder and wrist are stabilized, flexion strength of the elbow increases. 26 Better results are achieved in the setting of traumatic arm destruction compared to brachial plexus palsy, especially high palsies where the latissimus can be weakened preoperatively.…”

“…Spontaneously resolving hematoma, fibrofatty latissimus degeneration, loss of muscle tension requiring shortening, progressive myelopathy compromising the thoracodorsal nerve, 25 antagonistic co-contraction of the triceps resolving with botox injection, 5 and necrosis from a thrombosed pedicle, 28 and have each been described once. Skin necrosis and infection at the elbow site occurred in 2 of 21 various types of latissimus transfers, however both involved prior scarring and splinted in 150 degrees of flexion postoperatively.…”

Avaliação do ganho funcional do cotovelo com a cirurgia de Steindler na lesão do plexo braquial

“…In cases of impossibility of neurological reconstruction, failure in nerve transfers or insufficient return of muscle strength for elbow flexion, the tendon transfers for reestablishment of active elbow flexion are procedures to be indicated. 6 As a rule, we should attempt nerve reconstruction first, and when it does not present a good result or is no longer indicated, we can resort to muscle transfer surgeries, when possible, where the muscles used most often are: latissimus dorsi [7][8] , pectoralis major 9 , triceps 10,11 , flexor-pronator muscles of the forearm 2,12,13 and microsurgical free tissue transfers. 4,14,15 The proximal transfer of the flexor-pronator muscles of the forearm to the medial intermuscular septum of humerus (brachial fascia), was described by Steindler 16 .…”

Secondary Reconstructive Procedures in Obstetrical Brachial Plexus Palsy: Forearm, Wrist, and Hand Deformities

“…Secondary procedures such as muscle transfers and wrist fusion are necessary to improve function, especially in late cases in which the muscle targets have atrophied. Pedicled muscle or tendon transfers 14,[19][20][21] are used to enhance the functionality of the paretic arm. Advances in microsurgery began the era of free functional muscle transfer for brachial plexus paralysis management.…”