Total root avulsion injuries of brachial plexus: treatment analysis of 28 cases

Objective To introduce the surgical procedure and long term treatment outcome of total root avulsion injuries of brachial plexus. Methods From 1994 to 2001, 28 patients suffered from total root avulsion injuries of brachial plexus were treated with multi group nerve transfer, that is ,phrenic nerve to musculocutaneous nerve, intercostal nerve to median nerve, spinal accessory nerve to axillary nerve, contralateral C 7 root to radial nerve bridged by ulnar nerve. Results All the cases were followed up from 1.5 years to 5 years (mean 2.5 years). The results were as follows: shoulder abduction 30°in 20 cases, elbow flexion 90° in 19 , normal elbow extension in 11, wrist extension 40° in 16, normal phalanx and thumb extension in 11, wrist flexion 60°in 14 ,finger flexion to palmar crease in 10, restoration of forearm pronation in 13 .There was no active motion in the remainder case. The gross recovery rate was 75%. Conclusions There was reliable treatment outcome for function restoration of shoulder, elbow and wrist joint in the treatment of total brachial plexus root avulsion with multi group nerve transfer.