Long-Nerve Grafts and Nerve Transfers Demonstrate Comparable Outcomes for Axillary Nerve Injuries

Purpose To compare the functional and EMG outcomes of long-nerve grafts to nerve transfers for complete axillary nerve palsy. Methods Over a 10-year period at a single institution, 14 patients with axillary nerve palsy were treated with long-nerve grafts and 24 patients were treated with triceps-to-axillary nerve transfers by the same surgeon (S.W.W.). Data were collected prospectively at regular intervals, beginning before surgery and continuing up to 11 years after surgery. Prior to intervention, all patients demonstrated EMG evidence of complete denervation of the deltoid. Deltoid recovery (Medical Research Council [MRC] grade), shoulder abduction (degrees), improvement in shoulder abduction (degrees), and EMG evidence of deltoid reinnervation were compared between cohorts. Results There were no significant differences between the long-nerve graft cohort and the nerve transfer cohort with respect to postoperative range of motion, deltoid recovery, improvement in shoulder abduction, or EMG evidence of deltoid reinnervation. Conclusions These data demonstrate that outcomes of long-nerve grafts for axillary nerve palsy are comparable with those of modem nerve transfers and question a widely held belief that long-nerve grafts do poorly. When healthy donor roots or trunks are available, long-nerve grafts should not be overlooked as an effective intervention for the treatment of axillary nerve injuries in adults with brachial plexus injuries. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved.