American Society for Peripheral Nerve
ASPN Home ASPN Home Past & Future Meetings Past & Future Meetings

Back to 2023 Abstracts


Ultra-early Nerve Grafting in Complete Brachial Plexus Lesions: Benefits and Lessons Learned
Justus L Groen, MD PhD1; Martijn J.A. Malessy, MD, PhD2; Willem Pondaag, MD PhD3
1Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands; 2Neurosurgery, Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands; 3Neurosurgery, Leiden University Medical Center, Leiden, Netherlands

Introduction In complete traumatic brachial plexus lesions, the options to reanimate arm function are limited and outcome is generally poor. Reconstruction surgery is mostly delayed until at least three months for possible spontaneous recovery and demarcation of the nerve lesion to occur. The outcome of nerve surgery decreases when the interval between trauma and repair increases. Since 2009 we operate as early as possible to avoid the deleterious effect of prolonged denervation. Here we evaluate the results of supraclavicular nerve grafting and intercostal to musculocutaneous nerve transfer (ICN-MCN) for recovery of elbow flexion in complete lesions.
Methods We performed a retrospective chart review of all adult patients who were surgically treated for a traumatic BP injury between 2009-2019. Patients with a flail arm were included for this analysis. Biceps reanimation was the primary target of nerve surgery. Reconstruction consisted of supraclavicular nerve grafting or ICN-MCN transfer. Three groups were formed based on surgical delay after trauma: ultra-early (< 2 weeks), early (2 weeks- 3 months) and late (> 3 months).
Results Of 57 complete lesions, grafting was performed in 41 patients and ICN-MCN transfer in 16. MRC?4 was more frequent after ultra-early grafting (6/16, 38%) compared with early (3/10, 30%) and late (2/15, 13%)(p = 0.21). MRC3? was attained in 50% of ultra-early, 60% in early and 40% in the late group. The graft length was significantly shorter in the ultra-early group than in early and late (mean 47mm vs 73mm, p = 0,011). In the ultra-early group, 50% failure was noted (8/16): in 2 failures, the posterior division of the superior trunk was used as proximal stump; in 2 other patients, the anterior filaments of C6 were used as distal stump; one patient had a two-level lesion resulting in a C6-MCN gap of 12cm; in the 3 remaining failures no specific factor could be found. In ICN-MCN transfer MRC3? was more frequent in early group (8/10) vs late (1/6; p= 0.035), MRC4? was only obtained in the (ultra-)early group (4/10), not in the late group.
Conclusions In complete lesions, we pursue ultra-early grafting or early ICN-MC if no proximal stump is available. Exploration before 2 weeks resulted in a shorter graft length. However, this did not reflect in a significant better outcome in the present analysis, due to some failures we now know to avoid. Early ICN-MC resulted in biceps MRC?3 in 80% of patients


Back to 2023 Abstracts