Transferencias combinadas nerviosas para la lesión por avulsión del plexo…(I)

Somsak Leechavengvongs MD, , Kiat Witoonchart MD, Chairoj Uerpairojkit MD, Phairat Thuvasethakul MD and Kanchai Malungpaishrope MD

Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand.

Purpose To report the results of combined nerve transfer in C5 and C6 brachial plexus avulsion injury.

Methods Fifteen patients had nerve transfers: spinal accessory nerve to the suprascapular nerve, a part of the ulnar nerve to the biceps motor branch, and the nerve to the long head of the triceps to the anterior branch of the axillary nerve. Patients were evaluated with regard to elbow flexion, shoulder abduction, and shoulder external rotation.

Results All patients had recovered full elbow flexion: 13 scored M4 and 2 scored M3. Thirteen of the 15 patients obtained good results. The weight the patients could lift ranged from 0 to 7 kg. All patients had recovery of the deltoid function: 13 scored M4 and 2 scored M3. All 15 patients achieved useful functional recovery. Ten patients experienced excellent recoveries and 5 were classified as having good results. The mean shoulder abduction was 115°. Shoulder external rotation strength was scored as M4 in 9 patients, M3 in 4 patients, and M2 in 2 patients. The range of motion of external rotation that was measured from full internal rotation averaged 97°. No clinical donor nerve deficits were observed.

Conclusions We recommend combined nerve transfers for C5 and C6 avulsion root injuries. These nerve transfers have the advantage of a quick recovery time as a reult of the short regeneration distance without nerve graft.