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CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2024; 19(01): e1-e5
DOI: 10.1055/s-0043-1778063
Original Contribution

Intercostal Nerve Transfers to Native Triceps or Free Muscle Flaps for Elbow Extension in Brachial Plexus Injuries

Scott Ferris    *
1   Plastic, Hand and Faciomaxillary Surgery Unit, The Alfred Hospital, Victoria, Australia
2   Victorian Plastic Surgery Unit, St Vincent's Private Hospital Melbourne, Victoria, Australia
,
Simon Maciburko   *
1   Plastic, Hand and Faciomaxillary Surgery Unit, The Alfred Hospital, Victoria, Australia
2   Victorian Plastic Surgery Unit, St Vincent's Private Hospital Melbourne, Victoria, Australia
› Author Affiliations Funding None.
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Abstract

Intercostal nerve donors for traumatic brachial plexus injury reconstruction have been used to neurotize native muscles or free-functioning muscle transfers, with inconsistent outcomes reported. The aim was to record a substantial series, evaluate functional outcomes, and identify prognostic factors. We present a single-surgeon case series of 21 consecutive patients who underwent 21 transfer procedures to either native muscles or free-functioning muscles to reconstruct elbow extension over a 9-year period. Outcome parameters included target muscle power grade and timing of recovery. A Medical Research Council power grade ≥ M4 was achieved in 17 reconstructions. The free-functioning muscle group had significantly higher success rate and reached their best power grade 14 months earlier. Free-functioning muscle reconstruction with intercostal nerve transfer is a more complex procedure but has quicker functional recovery and greater reliability in achieving grade M4.

Keywords

intercostal nerve - brachial plexus - nerve transfer - free-functioning muscle transfer

* Both authors contributed equally to this study.




Publication History

Received: 16 September 2023

Accepted: 05 December 2023

Article published online:
22 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Doi K, Muramatsu K, Hattori Y. et al. Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results. J Bone Joint Surg Am 2000; 82 (05) 652-666
    CrossrefPubMedGoogle Scholar
  • 2 Kandenwein JA, Kretschmer T, Engelhardt M, Richter HP, Antoniadis G. Surgical interventions for traumatic lesions of the brachial plexus: a retrospective study of 134 cases. J Neurosurg 2005; 103 (04) 614-621
    CrossrefPubMedGoogle Scholar
  • 3 Kim DH, Cho YJ, Tiel RL, Kline DG. Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center. J Neurosurg 2003; 98 (05) 1005-1016
    CrossrefPubMedGoogle Scholar
  • 4 Allieu Y, Cenac P. Neurotization via the spinal accessory nerve in complete paralysis due to multiple avulsion injuries of the brachial plexus. Clin Orthop Relat Res 1988; (237) 67-74
    PubMedGoogle Scholar
  • 5 Gu YD, Wu MM, Zhen YL. et al. Phrenic nerve transfer for brachial plexus motor neurotization. Microsurgery 1989; 10 (04) 287-289
    CrossrefPubMedGoogle Scholar
  • 6 Gu YD, Zhang GM, Chen DS. et al. Cervical nerve root transfer from contralateral normal side for treatment of brachial plexus root avulsions. Chin Med J (Engl) 1991; 104 (03) 208-211
    PubMedGoogle Scholar
  • 7 Lykissas MG, Kostas-Agnantis IP, Korompilias AV, Vekris MD, Beris AE. Use of intercostal nerves for different target neurotization in brachial plexus reconstruction. World J Orthop 2013; 4 (03) 107-111
    CrossrefPubMedGoogle Scholar
  • 8 Morelli E, Morelli A. [Injuries of the brachial plexus]. Minerva Chir 1989; 44 (04) 749-754
    PubMedGoogle Scholar
  • 9 Narakas AO, Hentz VR. Neurotization in brachial plexus injuries. Indication and results. Clin Orthop Relat Res 1988; (237) 43-56
    PubMedGoogle Scholar
  • 10 Seddon HJ. Nerve grafting. J Bone Joint Surg Br 1963; 45: 447-461
    CrossrefPubMedGoogle Scholar
  • 11 Millesi H. Surgical management of brachial plexus injuries. J Hand Surg Am 1977; 2 (05) 367-378
    CrossrefPubMedGoogle Scholar
  • 12 Terzis JK, Vekris MD, Soucacos PN. Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis. Plast Reconstr Surg 1999; 104 (05) 1221-1240
    CrossrefPubMedGoogle Scholar
  • 13 Gao K, Lao J, Zhao X, Gu Y. Outcome after transfer of intercostal nerves to the nerve of triceps long head in 25 adult patients with total brachial plexus root avulsion injury. J Neurosurg 2013; 118 (03) 606-610
    CrossrefPubMedGoogle Scholar
  • 14 Liu Y, Lao J, Zhao X. Comparative study of phrenic and intercostal nerve transfers for elbow flexion after global brachial plexus injury. Injury 2015; 46 (04) 671-675
    CrossrefPubMedGoogle Scholar
  • 15 Krauss EM, Tung TH, Moore AM. Free functional muscle transfers to restore upper extremity function. Hand Clin 2016; 32 (02) 243-256
    CrossrefPubMedGoogle Scholar
  • 16 Medical Research Council: Nerve Injury Committee. Aids to examination of peripheral nerve Injuries. M.R.C. War Memorandum No. 7. London: His Majesty's Stationary Office; 1942: 48-74
    Google Scholar
  • 17 Raez MB, Hussain MS, Mohd-Yasin F. Techniques of EMG signal analysis: detection, processing, classification and applications. Biol Proced Online 2006; 8: 11-35
    CrossrefPubMedGoogle Scholar
  • 18 Chuang DC. Adult brachial plexus injuries. In: Mathes SJ, Hentz VR. eds. Plastic Surgery. Philadelphia: Saunders Elsevier; 2006. Vol. 7:515–538
    Google Scholar
  • 19 Kovachevich R, Kircher MF, Wood CM, Spinner RJ, Bishop AT, Shin AY. Complications of intercostal nerve transfer for brachial plexus reconstruction. J Hand Surg Am 2010; 35 (12) 1995-2000
    CrossrefPubMedGoogle Scholar
  • 20 Potter SM, Ferris SI. Reliability of functioning free muscle transfer and vascularized ulnar nerve grafting for elbow flexion in complete brachial plexus palsy. J Hand Surg Eur Vol 2017; 42 (07) 693-699
    CrossrefPubMedGoogle Scholar