Vascularized ulnar nerve graft: 151 reconstructions for posttraumatic brachial plexus palsy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Microsurgery

Background:

• Vascularized nerve grafts, introduced in 1976, have been suggested to offer superior outcomes.
• This study details 23 years of experience with vascularized ulnar nerve grafts for brachial plexus injuries.

Purpose of the Study:

• To evaluate the outcomes of vascularized ulnar nerve grafting over 23 years.
• To identify factors influencing outcomes in brachial plexus injury reconstruction.
• To compare vascularized ulnar nerve grafts with conventional nerve grafts.

Main Methods:

• 151 ulnar nerve reconstructions were performed between 1981 and 2003 for brachial plexus injuries in 67 patients.
• Patients were grouped based on graft type: ipsilateral pedicled/free ulnar nerve grafts, and contralateral ulnar nerve grafts to median nerve or single motor targets.
• Outcomes were assessed by comparing functional recovery based on denervation time, graft source, and target reinnervation.

Main Results:

• Early surgical intervention correlated with superior outcomes compared to long denervation times.
• Ipsilateral pedicle and free ulnar nerve grafts provided comparable results for biceps muscle neurotization.
• Contralateral ulnar nerve grafts were less effective for biceps neurotization than ipsilateral grafts.

Conclusions:

• Vascularized ulnar nerve grafting is a suitable solution for C8 and T1 root avulsion brachial plexus injuries, outperforming conventional grafts.
• While ipsilateral grafts are preferred, contralateral grafts for median nerve neurotization are being considered.
• Optimizing nerve reconstruction involves considering denervation time and donor graft location.