title: Primary restoration of elbow flexion in adult post-traumatic plexopathy patients.
abstract: Restoration of elbow flexion is one of the priorities in brachial plexus palsy, as this function brings the hand to the mouth. This study analyses the results of musculocutaneous nerve reconstruction in 194 patients with devastating paralysis. Results were analyzed in relation to denervation time, severity score, length of nerve grafts, and donor nerves used. Between 1978 and 2006, 194 post-traumatic plexopathy patients underwent musculocutaneous nerve reconstruction. 298 motor donors were used in 175 patients while 19 patients had microneurolysis. There were 104 intraplexus motor donors; 124 intercostal nerves were transferred in 39 patients; direct coaptation was performed in 31 patients and three or more intercostals were transferred in 33 patients; 16 patients underwent musculocutaneous to musculocutaneous repair. 144 patients had interposition nerve grafts. The mean follow-up was 4.48 ± 2.78 years. Results were good or excellent (≥M3+) in 52.53% of patients with more than 70° of elbow flexion. Patients, who were operated on less than 4 months from injury, with high severity score, attained significant better results than late cases with multiple root avulsions. Intraplexus donors have direct influence on biceps recovery, achieving significant better results than extraplexus donors. Intercostal nerves are an alternative source in avulsion injuries. The use of 3 intercostals with direct coaptation yielded optimal elbow flexion. Musculocutaneous nerve reconstruction is one of the priorities in upper limb reanimation. Functional outcomes are influenced by the age of the patient, severity of plexus lesion, denervation time, and type of reconstruction. Early surgery is recommended.
authors.affiliation: International Institute of Reconstructive Microsurgery, Long Island City (LIC), New York 11101, USA. jktmd1@aol.com
authors.forename: Julia K
authors.initials: JK
authors.lastname: Terzis
authors.forename: Antonia
authors.initials: A
authors.lastname: Barbitsioti
mesh_terms: D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015331:Cohort Studies; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009138:Musculocutaneous Nerve / Q000503:physiopathology / Q000601:surgery*; D009416:Nerve Regeneration / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult; D000092464:Elbow Injuries