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Supraclavicular intraplexal reconstruction may restore elbow flexion in infants
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Elbow flexion can be restored in infants with neonatal brachial plexus palsy who have neurotmesis of C5 and avulsion of C6 with supraclavicular intraplexal reconstruction with use of C5 as the proximal outlet, according to study results.
Of the 421 patients with neonatal brachial plexus palsy who underwent nerve surgery from 1990 to 2008, 34 infants who had a neurotmetic lesion of C5 and avulsion or intraforaminal neurotmesis of C6, irrespective of C7, were included in the study.
Researchers performed a transfer of the C6 anterior root filaments or the entire C6 nerve to C5 in 17 patients, with direct coaptation in 15 of the patients, and grafting from C5 to the anterior division of the superior trunk was performed in 17 infants. The researchers also applied an accessory-to-suprascapular nerve transfer in 29 infants.
By grafting from C5, the suprascapular nerve was reconnected in five patients. In 21 patients, the researchers were able to attach one, two or three additional grafts from C5 to the posterior division of the superior trunk.
All infants had biceps muscle recovery to a Medical Research Council grade of 4 or greater, 65% of patients obtained Mallet grade-IV abduction and 32% obtained Mallet grade-IV external rotation, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.
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