A 4-Year Follow-Up of End-to-Side Vascularized Ulnar Nerve Transfers in Complete Brachial Plexus Injury

The authors have already presented a 2-year follow-up of vascularized ulnar nerve transfer for complete root avulsion in Heidelberg in 2003, with fair results. A further follow-up at 4 years revealed acceptable outcomes. Eight of 13 patients could be followed up for 4 years; those patients who underwent this procedure after 2001 were excluded.

Two teams should cooperate simultaneously—one involved with the limb and the other with exploring the contralateral brachial plexus. In the involved hand, the distal stumps of the avulsed trunks should be explored and trimmed and the ulnar nerve, along with its vessels, should be raised based on the ulnar artery and vein under a bloodless field. The vessels should then be ligated just distal to trifurcation. At the same time, the upper and middle trunk of the contralateral plexus should be exposed, an elipse of epineurium anteromedial to these trunks should be excised, and a wound to the perineurium will be created. A proper tunnel from the left should be provided, the nerve should pass through the tunnel, nerve repair should be performed with 8-0 nylon under magnification, and the vessels hooked up at the recipient site. The other side of the nerve should be coapted to the median nerve and MC.

The Tinel sign started rapidly and proceeded for the first 6 months but then slowed gradually. Biceps contracture began within 2 years (1+). In 3 years, median-innervated muscles achieved 1+ and within 4 years, the biceps achieved 3+ and median-innervated muscles 2+. Sensation in the median territory was protective and two-point discrimination could not be determined. The authors believe that a combination of the described procedures along with conventional nerve transfer such as intercostal or spinal accessory nerve, may give the patients better results.