Elbow flexion is the first goal in upper partial brachial plexus palsy treatment. However, elbow extension is essential for daily living activities. To recover this function, one fascicle of ulnar nerve can be transferred to the branch of the long head of the triceps, but this procedure has been previously published in only two patients. The goal of our study is to assess a larger series of transfers of one fascicle of ulnar nerve to the branch of the long head of the triceps to help patients recover elbow extension. Ten male patients with C5, C6 and C7 brachial plexus injuries underwent operation. For shoulder recovery, we transferred the spinal accessory nerve and rhomboid nerve. For elbow flexion, one fascicle of median nerve was transferred to the nerve of the biceps. For elbow extension, we transferred one fascicle of ulnar nerve to the branch of the long head of the triceps. Tendon transfers were performed for wrist and finger extension. Nine patients recovered M4 elbow flexion and extension. One patient had M3 elbow extension and flexion. Average active shoulder elevation was 85° and average active shoulder external rotation was 65° All patients recovered finger and wrist extension. The classical techniques of grafts or phrenic or intercostal nerve transfers to recover elbow extension are not always reliable, according to the literature. Because the harvested ulnar nerve motor fascicle is close to the branch of the long head of the triceps, the recovery time for this procedure is shorter than that of other described nerve transfers. The isolated recovery of the reinnervated long head of the triceps muscle excludes spontaneous recovery occasionally noted in upper root plexus injuries. The transfer of one fascicle of ulnar nerve to the branch of the long head of the triceps is reliable for active elbow extension recovery in C5, C6 and C7 brachial plexus palsies.
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- Transfer of the intercostal nerves to the nerve of the long head of the triceps to recover elbow extension in brachial plexus palsy.Tech Hand Up Extrem Surg. 2007; 11: 139-141
- Transfer of a motor fascicle from the ulnar nerve to the branch of the radial nerve destined to the long head of the triceps for restoration of elbow extension in brachial plexus surgery: technical case report.Neurosurgery. 2012; 70 (discussion E20): E516-E520
- Results of surgical techniques for re-innervation of the triceps as additional procedures for patients with upper root injuries.J Hand Surg Am. 2013; 38 (European volume): 248-256
- Transfer of a terminal motor branch nerve to the flexor carpi ulnaris for triceps reinnervation: anatomical study and clinical cases.J Hand Surg Am. 2015;
- Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion.J Hand Surg Br. 1992; 17: 518-521
- Triceps brachii reinnervation in primary reconstruction of the adult brachial plexus: experience in 25 cases.Acta Neurochir (Wien). 2011; 153: 1999-2007
- Double fascicular nerve transfer for elbow flexion and extension.J Reconstr Microsurg. 2014; 30: 343-348
- Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy.J Bone Joint Surg Am. 2004; 86-A: 1485-1490
- Optimal axon counts for brachial plexus nerve transfers to restore elbow flexion.Plast Reconstr Surg. 2015; 135: 135e-141e
- Axon counts yield multiple options for triceps fascicular nerve to axillary nerve transfer.J Hand Surg Am. 2016; 41: e405-ee10
Published online: October 21, 2019
☆This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
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