Brachial plexus trauma: management by inter costal nerve transfer of the musculocutaneous nerve

ABSTRACT

Brachial plexus injuries are common in patients with road traffic accidents and missile injuries. Management is difficult and differs according to the level of the lesion. Intercostal nerve transfer is a well-established and effective technique for irreparable brachial plexus injuries. Thirteen cases of brachial plexus injuries were treated in the Department of Neuro Surgery, Bolan Medical College Quetta by intercostal to musculocutaneous nerve transfer, without nerve graft to obtain elbow flexion; between 1994 and 1998. The results were evaluated clinically using scale developed by Wright and used by Daniels, William and Worthingham. The overall success rate with motor functions of grade 4 or more was obtained in 65 percent of the patients. Factors contributing towards good results were early operation [less than 5 months after trauma], use of 3 intercostal nerves, mixed nerve to mixed nerve anastomosis, nerve repair without graft or tension and shoulder stability