Selective surgical reinnervationn of the axillary nerve due to supraclavicular brachial plexus injury: outcomes of 42 consecutive cases, causes of inefficacy
Keywords:injury, brachial plexus, selective surgical reinnervation, nerve transfer, axillary nerve
Objective: retrospective analysis of the outcomes of selective surgical reinnervation (SSR) of the axillary nerve (Ax) in patients with supraclavicular brachial plexus injury (SBPI).
Materials and methods. Forty-two patients (mean age 31.2 years) received 25 SSR with extraplexus donor nerves (e-ND) – 9 cases of subtotal SBPI and 16 cases of complete SBPI. In 17 cases of subtotal SBPI exclusively intraplexus donor nerve (i-ND) were utilized. Twenty-nine (69%) patients received SSR in terms up to 6 months, 13 patients (31%) – in terms more than 6 months. All patients at the time of inclusion were examined neurologically, electophisilogically and in 6, 9, 15 and 17 months. Recovery of the deltoid (D) muscle was assessed on Medical Research Council Scale (MRC Scale) – effective power (Еp). Recovery of effective function (Ef) has been assessed on the basis of flexion angle in glenohumeral joint in sagittal plane.
Results. Ер of D recovered in 12 patients (28%), in terms up to 6 months - in 31%, more than 6 months – in 23%. Ep of D recovered after SSR with i-ND in 9 patients (52%), in terms up to than 6 months - in 60%, more than 6 months – in 43%. Ep of D recovered after SSR with e-ND in 3 patients (12%), in terms up to 6 months- in 16%, no recovery of Ep has been observed in terms more than 6months.
Ef of D recovered in 11 patients (26%), in terms up to 6months - in 31%, more than 6months – in 15%. Ef of D recovered after SSR with i-ND in 8 patients (53%), in terms up to 6 months - in 60%, more than 6 months – in 29%. Ep of D recovered after SSR with e-ND in 3 cases (12%), in terms up to 6months - in 16%, no recovery of Ep has been observed in terms more than 6months. Recovery of Ef of D at subtotal SBPI occurred in 10 cases (38%), regardless of whether i-ND or e-ND have been utilized. SSR with e-ND at subtotal SBPI allowed restoring Ef of D in 2 cases (22%). SSR with i-ND at subtotal SBPI allowed restoring Ef of D in 8 cases (47%). SSR at complete SBPI allowed restoring Ef of D in 1 case (6%).
Conclusions. e-ND can be utilized at complete SBPI in order to provide stability to glenohumeral joint in terms up to 6 months; i-ND should be utilized in all cases of subtotal SBPI in order to provide Ef to D in terms up to 6 months.
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