Phrenic nerve transfer versus intercostal nerve transfer for the repair of brachial plexus root avulsion injuries

Abdixbir Abra; Li Ping; Ilhamjan Usman; Exmetjan Ysup

doi:10.3969/j.issn.2095-4344.2016.51.009

Abstract：BACKGROUND:Phrenic nerve transfer and intercostal nerve transfer are the accepted surgery strategies for the treatment of brachial plexus root avulsion injuries;however, which surgery is more suitable for the repair remains inconclusive. <br> OBJECTIVE:To observe the treatment outcomes of brachial plexus root avulsion injuries by transferring the phrenic nerve to the anterior division of the upper trunk of brachial plexus and the intercostal nerve to the musculocutaneous nerve. <br> METHODS:Twenty patients with brachial plexus root avulsion injuries were included. Among them, 9 were treated with phrenic nerve transfer to the anterior division of the upper trunk of brachial plexus (phrenic nerve transfer group), and 11 were treated with intercostal nerve transfer to the musculocutaneous nerve (intercostal nerve transfer group). Postoperative fol ow-up ranged from 15 to 36 months. Incision length, blood loss, and operation time were recorded. Muscle strength of the biceps and elbow flexion angle were evaluated. The repair outcome was evaluated by assessing the functional recovery of musculocutaneous nerve according to the criteria issued by the Branch of Hand Surgery of Chinese Medicine Association, and the excel ent and good rate was calculated. <br> RESULTS AND CONCLUSION:The excel ent and good rate was 66.7%and 63.6%, respectively, in phrenic nerve transfer group and intercostal nerve transfer group, which is not significantly different between both groups (P>0.05). Smal er length of operation incision, reduced blood loss, and shorter operation time were found in the phrenic nerve transfer group. Two and three patients in bad recovery were in phrenic nerve transfer and intercostal nerve transfer groups, respectively. These findings suggest that the two kinds of surgery strategies for the repair of brachial plexus root avulsion injuries can obtain good results in the functional recovery of elbow flexion. Phrenic nerve transfer exerts superiorities in operation incision, blood loss and operation time.