title: Distal nerve transfers are effective in treating patients with upper trunk obstetrical brachial plexus injuries: an early experience.
abstract: BACKGROUND
  Current surgical management of obstetrical brachial plexus injury is primary reconstruction with sural nerve grafts. Recently, the nerve-to-nerve transfer technique has been used to treat brachial plexus injury in adults, affording the benefit of distal coaptations that minimize regenerative distance. The purpose of this study was to test the hypothesis that nerve transfers are effective in reconstructing isolated upper trunk obstetrical brachial plexus injuries.
  
  
  METHODS
  Ten patients aged 10 to 18 months were treated with three nerve transfers: spinal accessory nerve to the suprascapular nerve for shoulder abduction and external rotation; a radial to axillary nerve for shoulder abduction; and ulnar or median nerve transfer to the musculocutaneous nerve for elbow flexion. Patients were assessed preoperatively and postoperatively using the Active Movement Scale. All patients were followed regularly for up to 2 years.
  
  
  RESULTS
  Improvement in elbow and shoulder function was observed between 6 and 24 months. By 6 months, all patients passed the cookie test. At 24 months, shoulder abduction improved from 3.7 ± 0.6 to 5.0 ± 0.5, shoulder external rotation from 1.8 ± 0.4 to 4.3 ± 0.6, shoulder flexion from 3.7 ± 0.5 to 5.4 ± 0.5, elbow flexion from 3.7 ± 0.6 to 6.3 ± 0.2, and forearm supination from 2.1 ± 0.4 to 5.9 ± 0.2. There was no clinically appreciable donor-site morbidity.
  
  
  CONCLUSIONS
  Nerve transfers reduced operative times compared with traditional nerve grafting procedures. Those patients showed significant gains in Active Movement Scale score by 24 months postoperatively, comparable to results achieved by nerve grafting. These findings support nerve transfers as a potential alternative treatment option for upper trunk obstetrical brachial plexus injuries.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Edmonton, Alberta, Canada From the Divisions of Plastic and Reconstructive Surgery and Physical Medicine and Rehabilitation, University of Alberta.
authors.forename: Adil
authors.initials: A
authors.lastname: Ladak
authors.forename: Michael
authors.initials: M
authors.lastname: Morhart
authors.forename: Kathleen
authors.initials: K
authors.lastname: O'Grady
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Wong
authors.forename: K Ming
authors.initials: KM
authors.lastname: Chan
authors.forename: M Joe
authors.initials: MJ
authors.lastname: Watt
authors.forename: Jaret L
authors.initials: JL
authors.lastname: Olson
mesh_terms: D000055:Accessory Nerve / Q000637:transplantation; D001365:Axilla / Q000294:innervation; D001720:Birth Injuries / Q000601:surgery*; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery*; D002675:Child, Preschool; D004551:Elbow Joint / Q000294:innervation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009416:Nerve Regeneration; D016067:Nerve Transfer / Q000379:methods*; D011826:Radial Nerve / Q000637:transplantation; D020127:Recovery of Function; D012785:Shoulder Joint / Q000294:innervation; D014459:Ulnar Nerve / Q000637:transplantation