Resumo

VERGARA-AMADOR, Enrique. Upper brachial plexus injuries. Reconstruction with combined techniques of neurotization and nerve grafts. rev.fac.med. [online]. 2015, vol.63, n.1, pp.93-98. ISSN 0120-0011.  https://doi.org/10.15446/revfacmed.v63n1.43406.

Background. The upper brachial plexus injuries are reconstructed with neurotization and nerve grafting. The spinal accessory nerve, C7 root, branches of the triceps, and median and ulnar nerve are most commonly used for transfers. Objective. To show the experience with neurotization of the lower branch of the spinal accessory nerve (NEA) to suprascapular nerve (NSE), nerve fascicles transfer of median or ulnar nerve, and sometimes nerve grafting to the musculocutaneous nerve and the posterior trunk, and axillary nerve reconstruction in some cases. Materials and methods. We reviewed 42 patients with upper brachial plexus injuries, operated by the combination transfer and nerve grafts. Minimum follow-up 15 months. Results. 40 patients were due to motorcycle accidents. In only 22 was transferred the NEA to NSE, recovering shoulder abduction of 33 °. In 8 patients to combine with axillary nerve repair, improved abduction to 81°. In 30 patients with ulnar or median nerve neurotization to the biceps, the response was obtained between 3 and 4 months. At follow- up elbow flexion was 116° and M4. Conclusion. The best results in shoulder were obtained with the combination of NSE and axillary nerve, achieving 81 ° of abduction. External rotation improved in 28.5% of patients, with a delayed response. Shoulder flexion of 116 was obtained with ulnar nerve neurotization, very comparable with other series. Today this technique is the gold standard for reconstruction of elbow flexion.

Palavras-chave : Brachial plexus; Nerve transfer; Ulnar nerve.

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