Nerve transposition for the restoration of elbow flexion following brachial plexus avulsion injuries

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✓ Despite technical advances, the ability to restore motor function following a brachial plexus avulsion is limited. Twenty patients who suffered the loss of elbow flexion following a brachial plexus avulsion injury underwent a neurotization procedure in an attempt to restore that lost function. Of 16 patients who underwent intercostal to musculocutaneous nerve anastomosis, seven obtained good elbow flexion. Four patients who no longer had a viable biceps brachialis muscle underwent an anastomosis between transposed intercostal nerves and a free vascularized gracilis muscle grafted to the position of the biceps. Two of these patients obtained good elbow flexion. Although synkinesis between the biceps brachialis and the inspiratory muscles can be demonstrated during coughing and deep inspiration, the patients learn to flex their reinnervated biceps brachialis muscle and maintain flexion independent of respiration.

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Address reprint requests to: Allan H. Friedman, M.D., Box 3807, Duke University Medical Center, Durham, North Carolina 27710.

© AANS, except where prohibited by US copyright law.

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Figures

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    Artist's drawing demonstrating exposure of the brachial plexus through the deltopectoral groove. The musculocutaneous nerve branches from the lateral cord at approximately the level of the coracoid process and travels to the biceps. Three intercostal nerves have been transposed into the field through the axilla.

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    Photographs in Case 1 demonstrating elbow flexion 18 months following an intercostal to musculocutaneous nerve anastomosis. In this patient, the proximal brachial plexus was explored prior to the anastomosis.

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