Background: For managing of upper brachial plexus palsy
in adult patients, many strategies should be discussed with
the patient. Primary plexus repair, nerve transfer, functional
muscle transfer and other musculoskeletal approaches may
be followed according the suitability, merits and disadvantages
of each. Time factorsare very crucial for the sound management
for these patients as time delay can result in a non-achievable
chance loss with the neuromuscular end plates loss within
two years following muscle denervation and progressive
musculoskeletal changes as well.
Patients and Methods: Between March 2013 and June
2015, six adult patients suffering from upper brachial plexus
injuries were referred to Zagazig University Hospital and
operated upon in two stages. In the first stage, two nerve
transfers were performed in the same setting; neurotization
of suprascapular nerve (using a branch of spinal root of the
accessory nerve to the suprascapular nerve) and Oberlin nerve
transfer (nerve fascicular transfer from the ulnar nerve to
biceps branch of the musculocutaneous nerve to reinnervate
the biceps muscle). After three to four months of the first
stage, the patients were operated upon in the second stage for
combined muscles transfers in the same setting i.e. trapezius
transfer to the humerus and latissimus dorsi with teres major
transfer to rotator calf of the shoulder.
Results: By the end of the tenth month of the first stage,
half of patients have regained M4 elbow flexion and the
remaining patients have been M3. These improvements have
been primarily noticed by the end of the third month postoperatively.
The range of elbow flexion has been gradually
improved to (100 to 120 degree against resistance) (mean 112
degree) with no noticeable deficit in the hand function as a
donor site morbidity. The second stage was done 3 to 4 months
from the first stage. Within 6 months of the second stage,
shoulder abduction ranged from 80 to 120 degree (mean 98)
with the mean of shoulder flexion 77 and externa rotation 47
degrees.
Conclusion: Multimodal association between distal nerves
transfer and combined transfer of trabezius, latissimus dorsi
and teres major muscles provides an effective and relatively
a short management scenario for upper brachial plexus injuries
in adult patients.