Modified double fascicular nerve transfer to restore elbow flexion in brachial plexus injuries - A series of 32 cases.

Abstract

Background: Elbow flexion restoration is one of the most important objectives of brachial plexus surgery in upper root injuries. Many authors have shown very good results with double fascicular nerve transfers and it has become the mainstay of nerve transfers for elbow flexion restoration. We present the results of a modified version of this double fascicular transfer.

Methods: A retrospective study of 32 patients who underwent the modified double fascicular nerve transfer(i.e median n to n to biceps and ulnar n to n to brachialis) was done. The average duration for delay in surgery from the time of injury was 5.6 months. The average age of the patients was 35.84. The average follow up of the patients was 39.3months.

Results: All patients had M0 or M1 power preoperatively. Eight patients had M3 power and 22 patients had M4 or M4+ power post operatively. Two patients did not recover meaningful elbow flexion. The results were similar to the original double fascicular nerve transfer for elbow flexion.

Conclusion: The modified version of the double fascicular nerve transfer is as reliable and produces similar results to the original double fascicular transfer. The theoretical advantages include the ease of doing the operation - (i) The n to biceps and median n are closer. (ii) The length of the n to brachialis allows it to be swung across the arm to reach the more posterior and medial ulnar nerve.