Nerve transfer in brachial plexus injuries: Comparative analysis of surgical procedures

Abstract

Nerve transfer is the only possibility for nerve repair in cases of the brachial plexus traction injuries with spinal roots avulsion. From 1980. until 2000. in Institute of Neurosurgery, Clinical Center of Serbia, nerve transfer has been performed in 127(79%) of 159 patients with traction injuries of brachial plexus, i.e., 204 reinnervation procedures has been performed using different donor nerves. We achieved good or satisfactory arm abduction and full range or satisfactory elbow flexion through reinnervation of the axillary and musculocutaneous nerve using different donor nerves in 143 of 204 reinnervations, which presents general rate of useful functional recovery in 70,1% of cases. Mean values of the rate of useful functional recovery in individual modalities of nerve transfer in our series are 50,1% for intercostal and/or spinal accessory nerve transfer, 64,5% for plexo-plexal nerve transfer, 81,7% for regional nerve transfer, and 87,1% for combine nerve transfer.Nervni transfer je jedina mogucnost nervne reparacije u slucajevima trakcionih povreda brahijalnog pleksusa uzrokovanih avulzijom spinalnih korenova. U periodu od 1980. godine zakljucno sa 2000. godinom u Institutu za neurohirurgiju Klinickog Centra Srbije nervni transfer izvrsen je kod 127 (79%) od 159 pacijenata sa trakcionom povredom, a ukupno su izvrsene 204 reinervacije koriscenjem razlicitih donornih nerava. Postigli smo dobru ili zadovoljavajucu abdukciju nadlaktice i zadovoljavajuci obim fleksije podlaktice reinervacijom aksilarisa i muskulokutaneusa koristeci razlicite donorne nerve u 143 od 204 reinervacije sto predstavlja opstu stopu funkcionalno korisnog oporavka od 70,1%. Srednja vrednost stope funkcionalno korisnog oporavka prema pojedinim modalitetima nervnog transfera u nasoj seriji iznosi za interkostalni nervni transfer, kao i za transfer spoljasnje grane akcesorijusa 50,1%, za plekso-pleksalni nervni transfer 64,5%, za regionalni nervni transfer 81,7%, i za kombinovani nervni transfer 87,1%.