Upper brachial plexus injuries: grafts vs ulnar fascicle transfer to restore biceps muscle function.
BACKGROUND
Nerve transfers or graft repairs in upper brachial plexus palsies are 2 available options for elbow flexion recovery.


OBJECTIVE
To assess outcomes of biceps muscle strength when treated either by grafts or nerve transfer.


METHODS
A standard supraclavicular approach was performed in all patients. When roots were available, grafts were used directed to proximal targets. Otherwise, a distal ulnar nerve fascicle was transferred to the biceps branch. Elbow flexion strength was measured with a dynamometer, and an index comparing the healthy arm and the operated-on side was developed. Statistical analysis to compare both techniques was performed.


RESULTS
Thirty-five patients (34 men) were included in this series. Mean age was 28.7 years (standard deviation, 8.7). Twenty-two patients (62.8%) presented with a C5-C6 injury, whereas 13 patients (37.2%) had a C5-C6-C7 lesion. Seventeen patients received reconstruction with grafts, and 18 patients were treated with a nerve transfer from the ulnar nerve to the biceps. The trauma to surgery interval (mean, 7.6 months in both groups), strength in the healthy arm, and follow-up duration were not statistically different. On the British Medical Research Council muscle strength scale, 8 of 17 (47%) patients with a graft achieved ≥ M3 biceps flexion postoperatively, vs 16 of 18 (88%) post nerve transfers (P = .024). This difference persisted when a muscle strength index assessing improvement relative to the healthy limb was used (P = .031).


CONCLUSIONS
The results obtained from ulnar nerve fascicle transfer to the biceps branch were superior to those achieved through reconstruction with grafts.
Nerve & Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina. Socolovsky@fibertel.com.ar
Mariano
M
Socolovsky
Roberto S
RS
Martins
Gilda
G
Di Masi
Mario
M
Siqueira
D000328:Adult; D001132:Arm; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000294:innervation* / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D014459:Ulnar Nerve / Q000637:transplantation*