Reconstruction of finger function in totally paralysed root avulsion type brachial plexus injuries with multiple nerve transfers and muscle transplantations.

概要

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The latissimus dorsi muscle transfer to restore flexion of the elbow has supplied satisfactory results in the field of reconstructive surgery. This technique was applied to the simultaneous reconstruction of elbow and finger function, combined with multiple nerve transfers, in totally paralysed avulsion type brachial plexus injuries. Our technique consisted of four steps. 1. Exploration of the injured brachial plexus to estimate the available upper cervical roots using the sensory evoked nerve potential, 2. Nerve grafts between the available roots and the median or radial nerve if the injury is postganglionic, and multiple muscle transfers with the latissimus dorsi or rectus femoris muscle to restore finger and elbow flexion, connecting to the FDP tendons at the forearm, 3. After some recovery of finger function, secondary muscle transplantation of the gracilis muscle to provide wrist extension is performed, 4. To control the intrinsic minus deformity of the fingers, a tenodesis is done. This technique had been applied to nine cases with a totally paralysed avulsion type brachial plexus injury. Their range of elbow motion was from minus 30 degrees in extension to 90 degrees in flexion. Their grasping power was between 2 and 4 (by manual muscle testing). Although normal usage still was not restored, this technique appears promising in totally paralysed avulsion type brachial plexus injuries.
西日本整形・災害外科学会の論文