Comparison of two procedures of intercostal nerve transfer for treatment of total brachial plexus root avulsion

Objective To compare the treatment outcome of intercostal nerve transfer to the musculocutaneous nerve by direct suture or via cutaneous nerve grafting.Methods Intercostal nerve transfer to the musculocutaneous nerve was done in 32 cases.In 20 cases, the intercostal nerve was mobilized for 10 - 13 cm.After being proved by electrical stimulation that it contains motor fibers,the intercostal nerve was transected and directly sutured with the musculocutaneous nerve.In the other 12 cases, intercostal nerve transfer to the musculocutaneous nerve via nerve graft (on average 10.2 cm in length) was done.The patients were followed for an average of 3 years to evaluate the muscle power of biceps brachii and recovery of elbow flexion.Results The rate of restoration of muscle power to MRC III or over MRC III was 75 % for direct suture group and 25 % for nerve graft group.Conclusions There was obvious recovery of elbow flexion after intercostal nerve transfer to musculocutaneous nerve.The result of direct suture was superior to that of nerve grafting.