title: Triceps brachii reinnervation in primary reconstruction of the adult brachial plexus: experience in 25 cases.
abstract: BACKGROUND
  Elbow flexion and shoulder abduction are the primary goals in brachial plexus surgery; however, reinnervation of the triceps is also an objective to be considered, as restoration of elbow extension improves the stabilization of the elbow and can provide a more powerful grasp. This study aims to demonstrate the author's experience with restoration of elbow extension function in cases of brachial plexus surgery in adults.
  
  
  METHODS
  Records of 25 patients sustaining traumatic brachial plexus injuries who were treated surgically with reinnervation of the triceps were reviewed. Nine techniques were employed, including posterior cord reconstruction and nerve transfers using donors such as the ipsilateral C7 root, phrenic nerve, medial pectoral nerve, intercostal nerves, the spinal accessory nerve, and a motor fascicle of the ulnar nerve. The targeted structure was the radial nerve or the branch to the long head of the triceps.
  
  
  RESULTS
  Twenty-one subjects (83%) obtained triceps reinnervation, and good results (M3 or better) were observed in 19 cases (76%). M4 grade was noted in 36% of the cases, M3 grade in 40%, M2 grade in 8%, M1 grade in 8%, and M0 grade in 8% of the patients. The best outcomes were observed in the cases presenting a C5 to C7 palsy and those in which the nerve to the triceps was chosen as the transfer target.
  
  
  CONCLUSIONS
  Reinnervation of the triceps can be achieved in most patients if adequate donor and recipient nerves are carefully selected based on an individual case-specific decision.
authors.affiliation: Unit of Neurosurgery, Hospital de Base do Distrito Federal, Post-Graduate Program in Medical Science, University of Brasília, SQN 208 Bloco F Apartamento 604, Asa Norte Brasília Distrito Federal, 70853-060, Brazil. leandroprettoflores@hotmail.com
authors.forename: Leandro Pretto
authors.initials: LP
authors.lastname: Flores
mesh_terms: D000293:Adolescent; D000328:Adult; D001132:Arm / Q000294:innervation / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation* / Q000601:surgery; D016067:Nerve Transfer / Q000379:methods*; D011843:Radiculopathy / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult