Results of nerve transfers to the musculocutaneous and axillary nerves

OBJECTIVE: Nerve transfers in cases of brachial plexus traction injuries with avulsion of spinal nerve roots or irreparable proximal lesions of spinal nerves have been attempted using a variety of donor nerves. The purpose of this study was to analyze the results of nerve transfers to the musculocutaneous and axillary nerves, using collateral branches of the brachial plexus, upper intercostal nerves, or the accessory nerve. METHODS: This study included 62 patients with brachial plexus traction injuries who were surgically treated using various nerve transfer techniques. The follow-up periods were at least 3 years. Analysis of motor recovery was performed according to the type of donor nerve, the age of the patient, and the timing of surgery. RESULTS: The rates of recovery for the musculocutaneous and axillary nerves were 50% and 63.2% with intercostal nerve transfers, 65% and 75% with accessory nerve transfers, and 90.4% and 86.9% with nerve transfers of collateral branches, respectively. Despite the obviously better outcomes with the latter technique, a significant difference was found only in comparison with intercostal nerve transfers for the musculocutaneous nerve (P = 0.007). With respect to the quality of recovery, we found a significant difference between the latter type and the other two types of nerve transfers only for the musculocutaneous nerve (P = 0.027 for intercostal nerve transfers and P = 0.05 for accessory nerve transfers). There was no significant difference in results obtained using the thoracodorsal and medial pectoral nerves as donors. CONCLUSION: Our findings suggest that nerve transfer of collateral branches when possible, such as in cases involving upper brachial plexus palsy, may be the method of choice, yielding better results.