ABSTRACT
AIMS: Between 2002 and 2011, 81 patients with a traumatic total brachial plexus injury underwent reconstruction by double free muscle transfer (DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve transfers (NT, 18 cases). METHODS: They were evaluated for functional outcome and quality of life (QoL) using the Disability of Arm, Shoulder and Hand questionnaire, both pre- and post-operatively. The three groups were compared and followed-up for at least 24 months. RESULTS: The mean shoulder abduction and flexion were comparable in all groups, but external rotation was significantly better in the DFMT group as were range and quantitative power of elbow flexion. Patients who had undergone DFMT had reasonable total active finger movement and hook grip strength. All groups showed improvement in function at a level greater than a minimum clinically important difference. The DFMT group showed the greatest improvement. DISCUSSION: Patients in the DFMT group had a better functional outcome and QoL recovery than those in the NT and SMT groups. TAKE HOME MESSAGE: Double free muscle transfer procedure is capable of restoring maximum function in patients of total brachial plexus palsy.
Subject(s)
Brachial Plexus/injuries , Muscle, Skeletal/transplantation , Nerve Transfer/methods , Adolescent , Adult , Brachial Plexus/surgery , Brachial Plexus Neuropathies/etiology , Brachial Plexus Neuropathies/physiopathology , Brachial Plexus Neuropathies/surgery , Elbow Joint/physiology , Female , Follow-Up Studies , Hand Strength/physiology , Humans , Male , Middle Aged , Postoperative Care/methods , Preoperative Care/methods , Quality of Life , Range of Motion, Articular/physiology , Recovery of Function/physiology , Surveys and Questionnaires , Treatment Outcome , Young AdultABSTRACT
The importance of external rotation of the shoulder is well accepted. Patients with inadequate recovery of shoulder function after nerve transfers for a brachial plexus injury have difficulty in using their reconstructed limb. The options for secondary procedures to improve shoulder function are often limited, especially if the spinal accessory nerve has been used earlier for nerve transfer or as a donor nerve for a free functioning muscle transfer. We have used the contralateral lower trapezius transfer to the infraspinatus in three cases, to restore shoulder external rotation. All patients had significant improvement in shoulder external rotation (mean 97°; range 80°-110°) and improved disability of the arm, shoulder and hand scores. The rotation occurred mainly at the glenohumeral joint, and was independent of the donor side. All patients were greatly satisfied with the outcome. Contralateral lower trapezius transfer appears to help in overall improvement of shoulder function by stabilizing the scapula. The results have remained stable after mean follow-up of 58 months (range 12-86). No donor site deficit was seen in any patient.
