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

Case report

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  • 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine; and
  • 2 The Neuroscience Program, Wake Forest University Graduate School of Arts & Sciences, Winston-Salem, North Carolina
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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.

Abbreviations used in this paper:BPI = brachial plexus injury; PIN = posterior interosseous nerve.

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Contributor Notes

Address correspondence to: Zhongyu Li, M.D., Ph.D., Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1070. email: zli@wakehealth.edu.

Please include this information when citing this paper: published online November 9, 2012; DOI: 10.3171/2012.10.JNS12425.

  • 1

    Ballesteros LE, & Ramirez LM: Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus. J Brachial Plex Peripher Nerve Inj 2:14, 2007

    • Search Google Scholar
    • Export Citation
  • 2

    Bertelli JA, & Ghizoni MF: Nerve root grafting and distal nerve transfers for C5–C6 brachial plexus injuries. J Hand Surg Am 35:769775, 2010

    • Search Google Scholar
    • Export Citation
  • 3

    Bertelli JA, & Ghizoni MF: Results and current approach for Brachial Plexus reconstruction. J Brachial Plex Peripher Nerve Inj 6:2, 2011

  • 4

    Brown JM, , Shah MN, & Mackinnon SE: Distal nerve transfers: a biology-based rationale. Neurosurg Focus 26:2 E12, 2009

  • 5

    Fu SY, & Gordon T: Contributing factors to poor functional recovery after delayed nerve repair: prolonged denervation. J Neurosci 15:38863895, 1995

    • Search Google Scholar
    • Export Citation
  • 6

    Garg R, , Merrell GA, , Hillstrom HJ, & Wolfe SW: Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis. J Bone Joint Surg Am 93:819829, 2011

    • Search Google Scholar
    • Export Citation
  • 7

    Isaacs J: Treatment of acute peripheral nerve injuries: current concepts. J Hand Surg Am 35:491497, 2010

  • 8

    Kerr AT: The brachial plexus of nerves in man, the variations in its formation and branches. Am J Anat 23:285395, 1918

  • 9

    Lowe JB III, , Sen SK, & Mackinnon SE: Current approach to radial nerve paralysis. Plast Reconstr Surg 110:10991113, 2002

  • 10

    Lowe JB III, , Tung TR, & Mackinnon SE: New surgical option for radial nerve paralysis. Plast Reconstr Surg 110:836843, 2002

  • 11

    Mackinnon SE, & Colbert SH: Nerve transfers in the hand and upper extremity surgery. Tech Hand Up Extrem Surg 12:2033, 2008

  • 12

    Mackinnon SE, , Roque B, & Tung TH: Median to radial nerve transfer for treatment of radial nerve palsy. Case report. J Neurosurg 107:666671, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Nunley JA, , Saies AD, , Sandow MJ, & Urbaniak JR: Results of interfascicular nerve grafting for radial nerve lesions. Microsurgery 17:431437, 1996

    • Search Google Scholar
    • Export Citation
  • 14

    Oberlin C, , Ameur NE, , Teboul F, , Beaulieu JY, & Vacher C: Restoration of elbow flexion in brachial plexus injury by transfer of ulnar nerve fascicles to the nerve to the biceps muscle. Tech Hand Up Extrem Surg 6:8690, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Okazaki M, , Al-Shawi A, , Gschwind CR, , Warwick DJ, & Tonkin MA: Outcome of axillary nerve injuries treated with nerve grafts. J Hand Surg Eur Vol 36:535540, 2011

    • Search Google Scholar
    • Export Citation
  • 16

    Omer GE: Timing of tendon transfers in peripheral nerve injury. Hand Clin 4:317322, 1988

  • 17

    Ray WZ, & Mackinnon SE: Clinical outcomes following median to radial nerve transfers. J Hand Surg Am 36:201208, 2011

  • 18

    Ropars M, , Dréano T, , Siret P, , Belot N, & Langlais F: Long-term results of tendon transfers in radial and posterior interosseous nerve paralysis. J Hand Surg Br 31:502506, 2006

    • Search Google Scholar
    • Export Citation
  • 19

    Sammer DM, & Chung KC: Tendon transfers: part I. Principles of transfer and transfers for radial nerve palsy. Plast Reconstr Surg 123:169e177e, 2009

    • Search Google Scholar
    • Export Citation
  • 20

    Shergill G, , Bonney G, , Munshi P, & Birch R: The radial and posterior interosseous nerves. Results of 260 repairs. J Bone Joint Surg Br 83:646649, 2001

    • Search Google Scholar
    • Export Citation
  • 21

    Suzuki K, , Doi K, , Hattori Y, & Pagsaligan JM: Long-term results of spinal accessory nerve transfer to the suprascapular nerve in upper-type paralysis of brachial plexus injury. J Reconstr Microsurg 23:295299, 2007

    • Search Google Scholar
    • Export Citation
  • 22

    Taylor GI: Free vascularized nerve transfer in the upper extremity. Hand Clin 15:673695, ixx, 1999

  • 23

    Tubbs RS, , Beckman JM, , Loukas M, , Shoja MM, & Cohen-Gadol AA: Median nerve branches to the pronator teres: cadaveric study with potential use in neurotization procedures to the radial nerve at the elbow. Laboratory investigation. J Neurosurg 114:253255, 2011

    • Search Google Scholar
    • Export Citation
  • 24

    Tung TH, & Mackinnon SE: Flexor digitorum superficialis nerve transfer to restore pronation: two case reports and anatomic study. J Hand Surg Am 26:10651072, 2001

    • Search Google Scholar
    • Export Citation

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