Nerve transfers for brachial plexus injuries

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Traumatic adult brachial plexus injuries are a devastating injury that result in partial or total denervation of the muscles of the upper extremity. Treatment of these injuries has been evolving over the past several decades. Treatment options include neurolysis, nerve grafting, neurotization (nerve transfer), or use of free functioning gracilis muscle transfers. Neurotization is the transfer of a functional but less important nerve to a denervated more important nerve. It has become an important procedure in the restoration of function in patients with brachial plexus injuries and allows the reinnervation of muscles that are affected by otherwise irreparable preganglionic lesions. The introduction of novel nerve transfers has improved shoulder abduction and elbow flexion, and in select cases, even provided a reasonable possibility for grasp function. This paper will review commonly used neurotizations in brachial plexus reconstruction, the rationale for their use, as well as techniques, results and controversies.

Section snippets

Spinal accessory nerve

The spinal accessory nerve (cranial nerve XI) innervates the sternocleidomastoid and trapezius muscles and has approximately 1,700 myelinated motor fibers.2 When harvested, it can be approached through the same transverse supraclavicular incision used to expose the supraclavicular brachial plexus. At the lateral margin of the wound, the spinal accessory nerve is identified several centimeters above the clavicle on the anterior surface of the trapezius (Fig. 1). A nerve stimulator is helpful in

Conclusions

Nerve transfers are being used increasingly by brachial plexus surgeons in different situations and combinations to achieve broader and better function. Their use in cases of preganglionic injury allows recovery in otherwise “irreparable” lesions. Nerve transfers can also be used instead of nerve grafting for postganglionic injuries, or to power free functioning muscle transfers. Nerve transfers have allowed a more rapid and reliable return of function than other existing techniques. Even in

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