Turkish Neurosurgery
Nerve Grafting vs. Common Infraclavicular Intraplexal Nerve Transfer in Elbow Flexion Restoration
Vesna Simić1, Andrija Savić2, Milan Jovanović3, Filip Vitošević5, Branko Đurović3, Čedomir Milošević6, Novak Lakićević7, Miroslav Samardžić3, Lukas Rasulić3
1General Hospital Cuprija, Department of Neurosurgery, Cuprija,
2Clinical Center of Serbia, Clinic for Neurosurgery, Belgrade,
3University of Belgrade, School of Medicine, Belgrade,
4Clinical Center of Serbia, Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade,
5Clinical Center of Serbia, Center for Radiology and MRI, Belgrade,
6Health Center Paracin, Department for First Aid and ER, Paracin,
7Clinical Center of Montenegro, Clinic for Neurosurgery, Podgorica,
DOI: 10.5137/1019-5149.JTN.20296-17.2
Aim:The aim of this study is to compare the results of nerve grafting vs. common infraclavicular intraplexal nerve transfer in elbow flexion restoration.Material and Methods:The study included 39 patients with upper brachial plexus palsy who were operated using common intraplexal nerve transfer (Oberlin procedure) and the thoracodorsal and medial pectoral nerve transfer to the musculocutaneous nerve or grafting of C5 to the musculocutneous nerve, for elbow flexion restoration. All patients underwent detailed preoperative evaluation, which included clinical and neurological examination, electrophysiological investigation and neuroradiological studies. The final evaluation of achieved recovery of elbow flexion was done two years after surgery, using the British Medical Council scale.Results:We achieved functional satisfactory recovery (M3, M4, M5) in 29 of 30 patients (96.7%) in the common intraplexal nerve transfer group, and in 4 of 9 patients in the nerve grafting group (44.4.%). There was a significant statistical difference between these two groups in favor of common intraplexal nerve transfers over C5 grafting to the musculocutaneous nerve regarding functional recovery.Conclusion:The results of our study concur with the findings of previous studies favoring intraplexal nerve transfers over nerve grafting in the restoration of elbow flexion in upper brachial plexus palsy. They reveal that intraplexal nerve transfers are clearly the primary treatment modality in cases of upper brachial plexus palsy without any sign of viable proximal C5 stump presence, while in cases of upper brachial plexus palsy with signs of viable proximal C5 stump the choice of the best treatment modality is still controversial.
Corresponding author : Lukas Rasulić