J Korean Soc Surg Hand.  2017 Sep;22(3):147-153. 10.12790/jkssh.2017.22.3.147.

Nerve Repair and Nerve Grafting in Brachial Plexus Injuries

• Lee TK
• Yoon JO
• Shin YH
• Kim JK

• KMID: 2391211
• DOI: http://doi.org/10.12790/jkssh.2017.22.3.147

Abstract

Brachial plexus injuries (BPI) can have devastating effects on upper extremity function, however, treatment in this injuries remains a difficult problem. Several kinds of surgical methods have been used to treat BPI, and nerve repair and nerve grafting have been traditionally used in postganglionic injury of brachial plexus. Because the several studies reported that nerve transfer to restore shoulder and elbow function has yielded superior results to historical reports for nerve grafting in partial BPI, the indication of nerve repair and nerve grafting has been decreased. Nonetheless, nerve repair and nerve grafting is still useful in focal damage in brachial plexus, such as laceration or gunshot wound and postganglionic neuroma in continuity without conduction of nerve action potential. In this paper, we described the basic concept, detailed indication and outcomes of nerve repair or nerve grafting in BPI.

Keyword

Brachial plexus injuries; Nerve graft

MeSH Terms

Action Potentials
Brachial Plexus*
Elbow
Lacerations
Nerve Transfer
Neuroma
Shoulder
Transplants*
Upper Extremity
Wounds, Gunshot

Figure

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  Fig. 1 The supraclavicular brachial plexus and the spinal nerve can be exposed through the transverse skin incision in the proximal portion of the clavicle (white arrow), and the deltopectoral approach allows the infraclavicular brachial plexus to be exposed (black arrow).

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  Fig. 2 In supraclavicular approach, omohyoid muscle (asterisk) was exposed after incision of the platysma and cervical fat pad.

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  Fig. 3 Upper trunk (asterisk) was exposed after incision of omohyoid muscle.

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  Fig. 4 About 4 cm nerve defect (A) was treated with cabled sural nerves graft (B).

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  Fig. 5 Sural nerve graft. (A) Skin incision for harvesting sural nerve. (B) Harvested sural nerve.

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  Fig. 6 Harvested vascularized ulnar nerve.

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