Secondary surgery following brachial plexus injuries

Berger, A.; Brenner, Peter J.

doi:10.1002/micr.1920160112

Cited by 50 publications

(20 citation statements)

References 6 publications

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Some authors have achieved excellent functional results with more than 75˚ of abduction and forward flexion 8,12 but in larger series these values were only 40˚ or less. 1,13,14 Our earlier experience of trapezius transfer has shown the importance of a reduction of joint instability in patients with brachial plexus palsy.…”

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confidence: 99%

Trapezius transfer in brachial plexus palsy

Rühmann

Schmolke

Bohnsack

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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Between March 1994 and June 2003, 80 patients with brachial plexus palsy underwent a trapezius transfer. There were 11 women and 69 men with a mean age of 31 years (18 to 69). Before operation a full evaluation of muscle function in the affected arm was carried out. A completely flail arm was found in 37 patients (46%). Some peripheral function in the elbow and hand was seen in 43 (54%). No patient had full active movement of the elbow in combination with adequate function of the hand. Patients were followed up for a mean of 2.4 years (0.8 to 8). We performed the operations according to Saha's technique, with a modification in the last 22 cases. We demonstrated a difference in the results according to the pre-operative status of the muscles and the operative technique. The transfer resulted in an increase of function in all patients and in 74 (95%) a decrease in multidirectional instability of the shoulder. The mean increase in active abduction was from 6 degrees (0 to 45) to 34 degrees (5 to 90) at the last review. The mean forward flexion increased from 12 degrees (0 to 85) to 30 degrees (5 to 90). Abduction (41 degrees) and especially forward flexion (43 degrees) were greater when some residual function of the pectoralis major remained (n = 32). The best results were achieved in those patients with most pre-operative power of the biceps, coracobrachialis and triceps muscles (n = 7), with a mean of 42 degrees of abduction and 56 degrees of forward flexion. Active abduction (28 degrees) and forward flexion (19 degrees) were much less in completely flail shoulders (n = 34). Comparison of the 19 patients with the Saha technique and the 15 with the modified procedure, all with complete paralysis, showed the latter operation to be superior in improving shoulder stability. In all cases a decrease in instability was achieved and inferior subluxation was abolished. The results after trapezius transfer depend on the pre-operative pattern of paralysis and the operative technique. Better results can be achieved in patients who have some function of the biceps, coracobrachialis, pectoralis major and triceps muscles compared with those who have a complete palsy. A simple modification of the operation ensures a decrease in joint instability and an increase in function.

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confidence: 99%

Trapezius transfer in brachial plexus palsy

Rühmann

Schmolke

Bohnsack

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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“…Muscle transfers have also been used to redundant paralyzed upper limbs. These have previously been neurotized by existing undamaged nerves or by the methods listed above (Berger and Becker, 1994;Alnot, 1995;Berger and Brenner, 1995). However, there are disadvantages in these procedures: donor nerve function is sacrificed, and a successful procedure requires regeneration of a nerve into a paralyzed muscle.…”

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confidence: 98%

Anatomical study to investigate the feasibility of pedicled nerve, free vessel gastrocnemius muscle transfer for restoration of biceps function

Cogswell

Giele

2001

Clinical Anatomy

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A challenging problem is the patient with a total brachial plexus injury with nerve root avulsions. In these patients nerve repair is not possible and no local functioning muscles are available for transfer. Current techniques involve either nerve repair using donor nerves from the contralateral limb or free muscle transfer neurotized by intercostal nerves. The problem with both these techniques is that they are dependent on neural regeneration, which is imperfect. To overcome the problem we propose a technique of transferring a distant muscle whilst retaining its neural supply. Gastrocnemius is a strong muscle and one suitable for free tissue transfer. This study assessed the possibility of transferring gastrocnemius on its neural supply by determining the length of nerve available and whether it was possible to dissect the nerve to gastrocnemius from the main body of the sciatic nerve. We found that the latter was possible, and that the length of dissected nerve would allow transfer of the innervated muscle from the calf to the axilla.

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“…For brachial plexus reconstruction, free muscles were used initially for elbow flexion [24], and since then, different muscles have been tried and different techniques have been proposed. Rectus femoris (RF) [1,13,17,18,39,41], latissimus dorsi (LD) [5,18,19,39], and gracilis [4,11,[13][14][15][16]19,39] were used with or without concomitant finger reanimation.…”

Section: Introductionmentioning

confidence: 99%

Free Muscle Transfer in Posttraumatic Plexopathies Part II: The Elbow

Terzis¹,

Kostopoulos

2009

Hand (New York, N,Y.)

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The indications for free muscle transfer in brachial plexopathies are prolonged denervation time or inadequate upper extremity function after primary nerve reconstruction. The purpose of this study is to analyze the outcomes of free muscle transfer for elbow flexion and extension in brachial plexopathies in relation to the different muscles used and the respective motor donors. Seventy-three muscles were transferred for elbow flexion and ten for elbow extension. Latissimus dorsi (LD) was used in 37 cases, gracilis in 28, rectus femoris (RF) in seven, and vastus lateralis in one. Five LD and five gracilis were transferred for elbow extension. Patients younger than 15 years yielded better results than older patients for elbow flexion. When LD was transferred, the mean muscle grading (MG) was 3.33±0.25 when the neurotization was from intercostals; these outcomes were statistically significant when compared with outcomes of free gracilis transfer (MG 2.25±0.6). There was also a statistically significant difference when free LD was neurotized with three intercostals as compared with two intercostals nerves. RF yielded also good results when neurotized from contralateral C7 (cC7; MG 3.67±0.6). For elbow extension, the better outcomes of LD were not statistically significant. Among all the free muscle transfers for upper extremity reconstruction, elbow reanimation yielded the most rewarding outcomes. The selection of powerful muscle units was more important than the effect of neurotization which was not as strong as it was in muscle transfers for facial or hand reanimation.

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Secondary surgery following brachial plexus injuries

Cited by 50 publications

References 6 publications

Trapezius transfer in brachial plexus palsy

Trapezius transfer in brachial plexus palsy

Anatomical study to investigate the feasibility of pedicled nerve, free vessel gastrocnemius muscle transfer for restoration of biceps function

Free Muscle Transfer in Posttraumatic Plexopathies Part II: The Elbow

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