Modification of intercostobrachial neurotization of musculocutaneous and axillary nerves in total brachial plexopathy: description of technique and literature review

BACKGROUND: Intercostobrachial neurotization is one of the few approach for partial motor recovery of extremity in patients with total trauma of brachial plexus. However, direct coaptation with musculocutaneous nerve is often impossible due to different anatomy of intercostal nerves and their functional failure at several levels. This necessitates the use of intermediate graft that deteriorates the final outcome. OBJECTIVE: To develop an alternative method for direct coaptation of musculocutaneous nerve with insufficiently long intercostal donor nerves. MATERIAL AND METHODS: The study included 26 patients with total post-traumatic plexitis. All patients underwent intercostobrachial neurotization of musculocutaneous and axillary nerves. Original technique of direct selective neurotization of motor fascicular groups of musculocutaneous and axillary nerves was used in 11 cases. RESULTS AND DISCUSSION: A modified variant of intercostobrachial neurotization of musculocutaneous and axillary nerves consists in mobilization and transposition of recipient nerves in axillary region. This makes it possible to reduce the distance to donor nerves and, in most cases, to carry out direct neurotization without autologous grafts. Among 11 patients, restoration of shoulder abduction and elbow flexion was obtained in 7 patients (77 %). CONCLUSION: The proposed adaptive technique makes it possible to avoid graft lengthening in some cases and provides satisfactory results.