title: Reanimation of elbow extension with intercostal nerves transfers in total brachial plexus palsies.
abstract: BACKGROUND
  Restoration of flexion in the elbow is the priority in the management of brachial plexus injuries. Current techniques of reconstructions, combining both nerve grafting and nerve transfer, allow more extensive repair, with additional targets: shoulder, elbow extension, hand. The transfer of intercostal nerves onto the nerve of the triceps long head is used to restore elbow extension. The aim of this retrospective study is to evaluate the results of this procedure, in total brachial plexus palsies with uninjured C5 and C6 roots.
  
  
  METHODS
  Eleven patients with total brachial plexus injury were reviewed 24 months in average after intercostal nerves transfer. The average age of the patients was twenty-nine years. The average time to surgery after occurrence of the injury was 5 months. Triceps re-innervation and strength of elbow extension were evaluated.
  
  
  RESULTS
  The averaged time required for triceps re-innervation after intercostal nerve transfer was 9 months. Seven patients achieved M4 elbow extension according to the Medical Research Council grading system. Two patients achieved M3 elbow extension. Two patients had poor results (M2 and M0).
  
  
  CONCLUSIONS
  Transfer of intercostal nerves onto the nerve of the triceps long head is a reliable procedure for the restoration of elbow extension in total brachial plexus palsy.
authors.affiliation: Centre International de Chirurgie de la Main, Clinique du Parc Monceau, 21 rue de Chazelles, 75017, Paris, France. jngoubier@gmail.com
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Goubier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Teboul
authors.forename: Heba
authors.initials: H
authors.lastname: Khalifa
mesh_terms: D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer; D013536:Suture Techniques; D055815:Young Adult