Results of nerve transfer surgery in the treatment of total root avulsion type brachial plexus injuries

Abstract

Surgical treatment in patients with total root avulsion type brachial plexus injuries is a major challenge in both donor sources of nerves and techniques. This study aims to assess the outcomes in 30 patients who had surgeries, with the unity of donor nerves and technique. 30 patients with total root avulsion or rupture brachial plexus injuries were treated with the accessory nerve (XI) to the suprascapular nerve transfer, and the total contralateral C7 to musculocutaneous, axillary, and median nerve transfer with 2 segments of vascularized ulnar nerve grafts in a surgery. The results were evaluated by BMRC, with the follow-up period of 18 months after surgery. Shoulder abduction angle ≥910 accounted for 73.3% (n=22/30); elbow flexion, wrist flexion, and finger flexion ≥M3 accounted for 76.7% (n=23/30), 43.3% (n=13/30), and 26.7% (n=8/30), respectively. The sensory recovery of the hand at level ≥S2 was found in 80% (n=24/30) patients. The accessory nerve (XI) to suprascapular nerve transfer surgery and the total contralateral C7 nerve to musculocutaneous, axillary, and median nerve transfer surgery with 2 segments of vascularized ulnar nerve grafts were safe and effective with stable donor nerves.