Results of c5 root grafting to the musculocutaneous nerve using pedicled, vascularized ulnar nerve grafts.
OBJECTIVE
Vascularized nerve grafts are indicated for the repair of large nerve defects. In brachial plexus injuries, the poor prognosis for functional hand reconstruction when the lower roots are avulsed makes the ulnar nerve a potential donor for vascularized nerve grafts. We report on the results we obtained with reconstruction of elbow flexion using long pedicled ulnar nerve grafts that connected the C5 root to the musculocutaneous nerve.


METHODS
We prospectively studied 8 young adults with complete brachial plexus palsy with avulsion of the lower roots, who had surgical repair an average of 4.6 months after trauma. Pedicled ulnar nerve grafts, averaging 30 cm long, connected the C5 root to the musculocutaneous nerve. In order to rescue misdirected axons that could have regenerated into the cutaneous branch of the musculocutaneous nerve, we transferred this branch to the motor branch of the extensor carpi radialis brevis muscle. Outcomes for all 8 patients were assessed an average of 26.7 months after surgery, focusing on recovery of muscle strength, categorized using the Medical Research Council scale.


RESULTS
None of the patients recovered elbow flexion or wrist extension greater than M2.


CONCLUSIONS
In brachial plexus injuries, reconstruction of elbow flexion using a long, pedicled, vascularized nerve graft produces unsatisfactory results.


METHODS
Therapeutic IV.
Bertelli
Jayme Augusto
JA
Governador Celso Ramos Hospital, Florianópolis, SC, Brazil. bertelli@matrix.com.br
Ghizoni
Marcos Flávio
MF
D000328:Adult; D001917:Brachial Plexus / Q000293:injuries*; D004550:Elbow / Q000294:innervation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D009138:Musculocutaneous Nerve / Q000601:surgery*; D009416:Nerve Regeneration / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D010291:Paresis / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D013126:Spinal Nerve Roots / Q000293:injuries* / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D020858:Tissue and Organ Harvesting / Q000379:methods; D017211:Treatment Failure; D014459:Ulnar Nerve / Q000637:transplantation*; D055815:Young Adult