Nerve transfers using collateral branches of the brachial plexus as donors in patients with upper palsy-thirty years' experience

Nerve transfers in cases of directly irreparable or high-level extensive brachial plexus traction injuries have been done using a variety of donor nerves with various success, but an ideal method has not been established. The purpose of this study is to analyze the results of nerve transfers using the thoracodorsal and medial pectoral nerves as donors in patients with upper palsy. This retrospective study included 40 patients with 29 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. Both nerves were used simultaneously in 22 of these patients. The thoracodorsal nerve was transferred in 13 patients to the musculocutaneous nerve and in nine patients to the axillary nerve. The medial pectoral nerve was transferred in nine patients to the musculocutaneous nerve and in 13 patients to the axillary nerve. The results were analyzed according to the donor nerve, the age of the patient, and the timing of surgery. The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100, 93.7, and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5, 83.3, and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery.