Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries

Abstract

<jats:p>Over the last 16 years, 345 surgical reconstructions of the brachial plexus were performed using nerve grafting or neurotization techniques in the Neurosurgical Department at the Nordstadt Hospital, Hannover, Germany. Sixty-five patients underwent graft placement between the C-5 and C-6 root and the musculocutaneous nerve to restore the flexion of the arm. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 54 patients: 1) time interval between injury and surgery; 2) choice of the donor nerve (C-5 or C-6 root); and 3) length of the grafts used for repairs between the C-5 or C-6 root and the musculocutaneous nerve.</jats:p> <jats:p>The postoperative follow-up interval ranged from 9 months to 14.6 years, with a mean ± standard deviation of 4.4 ± 3 years. Reinnervation of the biceps muscle was found in 61% of the patients. Comparison of the different preoperative time intervals (1-6 months, 7-12 months, and &gt; 12 months) showed a significantly better outcome in those patients with a preoperative delay of less than 7 months (p &lt; 0.05). Reinnervation of the musculocutaneous nerve was demonstrated in 76% of the patients who underwent surgery within the first 6 months postinjury, in 60% of the patients with a delay of between 6 and 12 months, and in only 25% of the patients who underwent surgery after 12 months. Comparison of the final outcome according to the root (C-5 or C-6) that was used for grafting the musculocutaneous nerve showed no statistical difference.</jats:p> <jats:p>Furthermore, statistical analysis (regression test) of the length of the grafts between the donor (C-5 or C-6 root) nerve and the musculocutaneous nerve displayed an inverse relationship between the graft length and the postoperative outcome.</jats:p> <jats:p>Together, these results provide additional information to enhance the functional outcome of brachial plexus surgery.</jats:p>

Brachial plexus injury: factors affecting functional outcome in spinal accessory nerve transfer for the restoration of elbow flexion

“…We have also previously reported an inverse relationship between graft length and functional recovery. 38 In the present study, shorter grafts (Ͻ 12 cm) have shown a positive impact on the restoration of elbow flexion in nerve transfer from the accessory nerve to the musculocutaneous nerve, compared with longer grafts (Ͼ 12 cm). Patients treated with nerve grafts shorter than 12 cm showed a significantly higher reinnervation rate compared with patients treated with grafts longer than 12 cm.…”

“…38 In the current study, a significantly better outcome in elbow flexion after nerve transfer with the accessory nerve occurred in patients treated during the first 6 months after brachial plexus injury.…”

“…2,3,12,23,29,38 A poor coaptation and tension at the nerve union site will stimulate the proliferation of scar tissue and further development of fibrosis and granulomas at that location, which may impair the regeneration of growing axons. 25,36,38 Conclusions Data from this clinical study demonstrate that the outcome after nerve transfer of spinal accessory nerve to the musculocutaneous nerve for restoration of elbow flexion in in patients who underwent surgery 7 to 12 months after injury. Note the highly significant difference between the two groups (p Ͻ 0.002).…”

Motoneuron survival after chronic and sequential peripheral nerve injuries in the rat

“…6,7 Poor outcome from clinical peripheral nerve injury is especially evident when repair is performed in a delayed fashion. 22,25,[43][44][45]47,48 This has been variously attributed to the lengthy periods of chronic axotomy (defined as the period during which injured neurons remain without target connections) and of chronic denervation of distal Schwann cells and target organs. These conditions independently and collectively progressively reduce regenerative capacity, as we have previously documented and reviewed.…”

Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function

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OR treatment of brachial plexus injury with nerve root avulsion a number of nerves have been used for neurotization, 12,15,17 including the intercostal, accessory, 9 and the hypoglossal nerves, 8 the contralateral brachial plexus nerve roots, 5 and the motor branches of the cervical plexus. 20 The sheer number of different treatment options clearly indicates that there is no ideal one.

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