Clinical application and efficacy of multiple nerve transfers for treatment of brachial plexus upper trunk injuries

Objective To investigate the results of multiple nerve transfers for treatment of complex brachial plexus upper trunk injuries.Methods Between March 2009 and June 2012,7 patients who sustained brachial plexus upper trunk injuries with concomitant phrenic nerve and middle and lower trunk partial injuries were treated with accessory nerve transfer,intercostal nerve transfer and triceps long head branch transfer to restore shoulder abduction and elbow flexion.Results All the patients were follow-up for 17 to 26 months postoperatively.Nascent potentials were recorded in the recipient muscles in all the patients 4 to 6 months after the surgery.At last follow-up evaluation shoulder abduction returned to 60° to 130°,with supraspinatus and infraspinatus muscle power of M4 in 6 cases,M3 in 1 case and deltoid muscle power of M4 in 5 cases and M3 in 2 cases.Elbow flexion returned to 90° to 130°,with biceps muscle power of M4 in 5 cases and M3 in 2 cases.There was no impairment of motor functions related to the donor nerves.Conclusion Multiple nerve transfers,involving accessory nerve,intercostal nerves and the triceps long head branch,may achieve a better treatment outcome in complex brachial plexus upper trunk injuries. Key words: Brachial plexus;  Nerve transfer;  Treatment outcome;  Upper trunk injury