Neurotization of Brachial Plexus Injury

Han, Chung Soo; Chung, Duke Whan; Shin, Dong Joon; Im, Yang Sun

Abstract

PURPOSE
The aim of this study was to determine the result of neurotization on brachial plexus injury. MATERIALS AND METHODS: 51 patients (87 procedures) who were observed for more than 18 months after neurotization were chosen as subjects. The average follow-up period was 62.8 months, the mean age of patients was 27.8 years, and the average time between the injury and operation was 6.1 months. We performed 60 procedures of the whole arm type, 26 procedures of the upper arm type and 1 procedure of the lower arm type. The intercostal nerve, spinal accessory nerve, the contralateral 7th cervical (C7) nerve, and the phrenic nerve were used as donor nerves. The British Research Council System was used to evaluate the extent of recovery of upper limb function, and the time to first recovery of the muscle was noted. We also analysed results according to the type of injury, time between injury and surgery, and age. RESULTS: 30 procedures showed excellent results, 34 procedures good, 9 procedures fair and 14 procedures poor. In 64 procedures (73.6%) recovery of muscle strength was good or better, and in 73 procedures (83.9%) a recovery of muscle contraction was observed. The earliest evidence of recovery of muscle contraction was observed 6.4 months after using the intercostal nerve. When the contralateral C7 nerve was used, muscle contraction was most delayed. Surgery performed soon after injury and in younger patients produced the best clinical outcomes. CONCLUSION: We report that more than 2/3rds of the patients who received neurotization achieved at least a good result, which allowed a certain level of daily activity.