Use of long autologous nerve grafts in brachial plexus reconstruction: factors that affect the outcome

Masi

Bonilla

et al. 2017

ONSURG

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Section: Clinical Seriesmentioning

confidence: 99%

Age as a Predictor of Long-Term Results in Patients with Brachial Plexus Palsies Undergoing Surgical Repair

Masi

Bonilla

et al. 2017

ONSURG

Self Cite

“…[11171820] Body mass index (BMI), which reflects a patient's weight relative to height, has only recently been reported as yet another prognostic factor, with its influence appearing not to be as strong as the timing of surgery. [93132]…”

Section: Introductionmentioning

confidence: 99%

A literature review of intercostal-to-musculocutaneous-nerve transfers in brachial plexus injury patients: Does body mass index influence results in Eastern versus Western countries?

Domínguez-Páez

2013

Surg Neurol Int

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Background:A wide range of results have appeared in the literature for intercostal nerve transfers in brachial plexus patients. Oriental countries generally have a lower body mass index (BMI) than their occidental counterparts. We analyzed published series of intercostal nerve transfers for elbow reinnervation to determine if a difference in outcomes exists between Eastern and Western series that could be inversely related to BMI.Methods:A PubMed search was conducted. Inclusion criteria were: (1) time from trauma to surgery <12 months, (2) minimum follow-up one year, (3) intercostal to musculocutaneous nerve transfer the only surgical procedure performed to reestablish elbow flexion, and (4) males comprising more than 75% of cases. Two groups were created: Series from western countries, including America, Europe, and Africa; and series from Asia. Pearson correlation analysis was performed to assess for the degree of correlation between percent responders and mean national BMI.Results:A total of 26 series were included, 14 from western countries and 12 from Eastern countries, encompassing a total of 274 and 432 surgical cases, respectively. The two groups were almost identical in mean age, but quite different in mean national BMI (26.3 vs. 22.5) and in the percentage of patients who achieved at least a Medical Research Council (MRC) level 3 (59.5% vs. 79.3%). Time from trauma to surgery was slightly shorter in Eastern (3.4 months) versus Western countries (5.0 months).Conclusions:The percentage of responders to intercostal to musculocutaneous nerve transfer was inversely correlated with the mean national BMI among male residents of the country where the series was performed.

“…Several studies 19,[27][28][29][30] have provided convincing evidence supporting the use of long grafts. Such grafts have been documented to facilitate the growth of regenerating nerve fibers toward a more selective target, avoiding axon misrouting and bypassing possible areas of distal double crush.…”

Section: Triceps Reinnervation: Proximal Versus Distal Targetsmentioning

confidence: 99%

Phrenic Nerve Transfer for Reconstruction of Elbow Extension in Severe Brachial Plexus Injuries

Flores¹,

2016

J reconstr Microsurg

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Background Restoring elbow extension is an important objective to pursue when repairing the brachial plexus in patients with a flail arm. Based upon the good results obtained using the phrenic nerve to restore elbow flexion and shoulder stability, we hypothesized that this nerve could also be employed to reconstruct elbow extension in patients with severe brachial plexus injuries. Methods A retrospective study of 10 patients in which the phrenic nerve targeted the radial nerve (7 patients) or the branch to the long head of the triceps (3 patients) as a surgical strategy for reconstruction of the brachial plexus. Results The mean postoperative follow-up time was 34 months. At final follow-up, elbow extension graded as M4 was measured in three patients, Medical Research Council MRC M3 in five patients, and M2 in one patient, while one patient experienced no measurable recovery (M0). No patient complained or demonstrated any signs of respiratory insufficiency postoperatively. Conclusions The phrenic nerve is a reliable donor for reanimation of elbow extension in such cases, and the branch to the long head of the triceps should be considered as a better target for the nerve transfer.