J Brachial Plex Peripher Nerve Inj 2011; 06(01): e54-e61
DOI: 10.1186/1749-7221-6-2
Review
Bertelli and Ghizoni; licensee BioMed Central Ltd.

Results and current approach for Brachial Plexus reconstruction[*]

Jayme A Bertelli
1   Center of Biological and Health Sciences, University of Southern Santa Catarina (Unisul). Tubarão, SC, Brazil
,
Marcos F Ghizoni
2   Center of Biological and Health Sciences, University of Southern Santa Catarina (Unisul). Tubarão, SC, Brazil
› Author Affiliations

Subject Editor:
Further Information

Publication History

04 January 2011

16 June 2011

Publication Date:
23 September 2014 (online)

Abstract

We review our experience treating 335 adult patients with supraclavicular brachial plexus injuries over a 7-year period at the University of Southern Santa Catarina, in Brazil. Patients were categorized into 8 groups, according to functional deficits and roots injured: C5-C6, C5-C7, C5-C8 (T1 Hand), C5-T1 (T2 Hand), C8-T1, C7-T1, C6-T1, and total palsy. To restore function, nerve grafts, nerve transfers, and tendon and muscle transfers were employed. Patients with either upper- or lower-type partial injuries experienced considerable functional return. In total palsies, if a root was available for grafting, 90% of patients had elbow flexion restored, whereas this rate dropped to 50% if no roots were grafted and only nerve transfers performed. Pain resolution should be the first priority, and root exploration and grafting helped to decrease or eliminate pain complaints within a short time of surgery.

*This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


 
  • References

  • 1 Robotti E, Longhi P, Verna G, Bocchiotti G. Brachial plexus surgery: an historical perspective. Hand Clin 1995; 4: 517-533
  • 2 Bertelli JA, Ghizoni MF. Use of clinical signs and computed tomography myelography findings in detecting and excluding nerve root avulsion in complete brachial plexus palsy. J Neurosurg 2006; 105: 835-842 10.3171/jns.2006.105.6.835 17405253
  • 3 Bertelli JA, Ghizoni MF. Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction. J Neurosurg 2004; 101: 770-778 10.3171/jns.2004.101.5.0770 15540915
  • 4 Bertelli JA, Ghizoni MF. Reconstruction of C5 and C6 brachial plexus avulsion injury by multiple nerve transfers: spinal accessory to suprascapular, ulnar fascicles to biceps branch, and triceps long or lateral head branch to axillary nerve. J Hand Surg Am 2004; 29: 131-139 10.1016/j.jhsa.2003.10.013 14751116
  • 5 Bertelli JA, Ghizoni MF. Nerve root grafting and distal nerve transfers for C5-C6 brachial plexus injuries. J Hand Surg Am 2010; 35: 769-75 10.1016/j.jhsa.2010.01.004 20346595
  • 6 Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P, Malungpaishrope K. Combined nerve transfers for C5 and C6 brachial plexus avulsion injury. J Hand Surg Am 2006; 31: 183-189 10.1016/j.jhsa.2005.09.019 16473676
  • 7 Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using part of ulnar nerve for C6-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am 1994; 1: 232-237
  • 8 Bertelli JA, Ghizoni MF. Results of grafting the anterior and posterior divisions of the upper trunk in complete palsies of the brachial plexus. J Hand Surg Am 2008; 33: 1529-1540 10.1016/j.jhsa.2008.06.007 18984335
  • 9 Bertelli JA, Ghizoni MF. Reconstruction of complete palsies of the adult brachial plexus by root grafting using long grafts and nerve transfers to target nerves. J Hand Surg Am 2010; 35: 1640-1646 10.1016/j.jhsa.2010.06.019 20843615
  • 10 Bertelli JA, Ghizoni MF. Results of C5 root grafting to the musculocutaneous nerve using pedicled, vascularized ulnar nerve grafts. J Hand Surg Am 2009; 34: 1821-1826 10.1016/j.jhsa.2009.08.004 19969189
  • 11 Bertelli JA, Ghizoni MF, Loureiro Chaves DP. Sensory disturbances and pain complaints after brachial plexus root injury: A prospective study involving 150 adult patients. Microsurgery 2011; 31: 93-97 10.1002/micr.20832 20939002
  • 12 Bertelli JA, Ghizoni MF. Pain after avulsion injuries and complete palsy of the brachial plexus: the possible role of non avulsed roots in pain generation. Neurosurgery 2008; 62: 1104-1113 10.1227/01.neu.0000325872.37258.12 18580808
  • 13 Wynn-Parry CB. Pain in avulsion lesions of the brachial plexus. Pain 1980; 9: 41-53 10.1016/0304-3959(80)90027-5 6968424
  • 14 Bertelli JA, Ghizoni MF. The possible role of regenerating axons in pain persistence after brachial plexus grafting. Microsurgery 2010; 30: 532-536 10.1002/micr.20788 20853337
  • 15 Quintão NL, Santos AR, Campos MM, Calixto JB. The role of neurotrophic factors in genesis and maintenance of mechanical hypernociception after brachial plexus avulsion in mice. Pain 2008; 136: 125-133 10.1016/j.pain.2007.06.027 17706869
  • 16 Bertelli JA, Ghizoni MF. Brachialis muscle transfer to reconstruct finger flexion or wrist extension in brachial plexus palsy. J Hand Surg Am 2006; 31: 190-196 10.1016/j.jhsa.2005.09.020 16473677
  • 17 Bertelli JA, Tacca CP, Duarte ECW, Ghizoni MF, Duarte H. Transfer of Axillary Nerve Branches to Reconstruct Elbow Extension in Tetraplegics. A Laboratory Investigation of Surgical Feasibility. Microsurgery 2011; Apr 18. PubMed PMID: 21503973
  • 18 Bertelli JA, Ghizoni MF, Tacca CP. Transfer of Teres Minor Motor Branch for Triceps Reinnervation in Tetraplegia: A Case Report. J Neurosurg 2011; 114 (5) 1457-60 May: Epub 2011 Jan 21. PubMed PMID: 21250798 21250798
  • 19 Bertelli JA, Kechele PR, Santos MA, Besen BA, Duarte H. Anatomical feasibility of transferring supinator motor branches to the posterior interosseous nerve in C7-T1 brachial plexus palsies. Laboratory investigation. J Neurosurg 2009; 111: 326-331 10.3171/2008.10.08859 19199496
  • 20 Bertelli JA, Ghizoni MF. Transfer of supinator motor branches to the posterior interosseous nerve in C7-T1 brachial plexus palsy. J Neurosurg 2010; 113: 129-132 10.3171/2009.10.JNS09854 19895203
  • 21 Bertelli JA, Ghizoni MF, Tacca CP. Transfer of the supinator muscle to the extensor pollicis brevis for thumb extension reconstruction in C7-T1 brachial plexus palsy. J Hand Surg Eur 2010; 35: 29-31
  • 22 Mohammed KD, Rothwell AG, Sinclair SW, Willems SM, Bean AR. Upper-limb surgery for tetraplegia. J Bone Joint Surg Br 1992; 74: 873-879 1447249
  • 23 Brandsma JW, Brand PW. Claw-finger correction. Considerations in choice of technique. J Hand Surg Br 1992; 17: 615-621 10.1016/0266-7681(92)90185-5 1484242