Brachial plexus injuries in the adult. nerve transfers: the Siriraj Hospital experience
Section snippets
Materials and methods
From October 1984 to October 2003, 1449 adult patients with traumatic brachial plexus palsy were treated at Siriraj Hospital (Bangkok, Thailand). There were 1157 nerve transfers performed in these patients to restore the affected limb function.
The fifth to sixth cervical nerve stump
In patients with avulsions of C6 throughT1 or C7 through T1 roots, the extraforminally injured C5 or C6 roots or both can be used as donors for plexo-plexal nerve grafting. The most frequently encountered problem with this method of intraplexal nerve grafting is co-contraction of antagonistic muscles. Another commonly encountered problem of plexo-plexal grafting is the method used to determine whether the root stump is an appropriate donor. At present, the use of the microscopic appearance of
Hemicontralateral C7
In 1986, Gu first transferred the C7 nerve root from the contralateral side to treat a complete brachial plexus avulsion injury. In 1991, Brunelli observed that an isolated avulsion of the C7 nerve root produced only a minimal degree of morbidity in the affected limb. Theoretically, this surgical procedure greatly helps surgeons solve the problem of donor axon inadequacy because the C7 root contains 18,000 to 40,000 fibers. In the current authors' practice, only half of the contralateral C7 is
Summary
A strategy that uses the selective combination of neurotizations can yield a moderate degree of shoulder and elbow control. Even though some wrist and finger movement can occasionally be achieved by the current methods of neurotization, the results in terms of restoration of useful hand function are still far from satisfactory. The use of intraplexal and contralateral plexal neurotization combined with free-functioning muscle transfer and the better understanding of central-peripheral function
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