Article

Combined proximal nerve graft and distal nerve transfer for a posterior cord brachial plexus injury Case report

Department of Orthopaedic Surgery, Wake Forest School of Medicine
Journal of Neurosurgery (Impact Factor: 3.74). 11/2012; 118(1). DOI: 10.3171/2012.10.JNS12425
Source: PubMed

ABSTRACT

The treatment of patients with prolonged denervation from a posterior cord brachial plexus injury is challenging and no management guidelines exist to follow. The authors describe the case of a 26-year-old man who presented to our clinic for treatment 11 months after suffering a high-energy injury to the posterior cord of the brachial plexus. A combined 9-cm proximal cable nerve graft procedure and a pronator branch to the posterior interosseous nerve transfer were performed. Satisfactory deltoid, triceps, wrist, and finger extensor recovery was noted 3 years after surgery. Patients with prolonged denervation from posterior cord injuries can be successfully treated with a combination of a proximal nerve graft and a distal nerve transfer.

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    ABSTRACT: Purpose: To evaluate outcomes following transfer of the supinator motor branch of the radial nerve (SMB) to the posterior interosseous nerve (PIN) and the pronator teres motor branch of median (PTMB) to the anterior interosseous nerve (AIN) in patients with lower brachial plexus injuries. Methods: Since December 2010, 4 patients have undergone combined transfer of the SMB to PIN and PTMB to AIN for lower brachial plexus palsies. The study was prospectively designed, and the patients were followed for 4 years to monitor their functional improvement. Results: One patient failed to return after his 4-month postoperative visit. The other 3 patients all regained M4 thumb and finger extension, and 2 recovered M4 thumb and finger flexion at the final evaluation, a mean 30 months after the nerve transfer surgeries. Conclusions: Combined transfer of the SMB to PIN and PTMB to AIN may lead to successful recovery of digital extrinsic flexion and extension in lower brachial plexus injuries. Type of study/level of evidence: Therapeutic IV.
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