Long Thoracic Nerve Transfer for Children With Brachial Plexus Injuries

Area of Science:

• Orthopedics
• Neurosurgery
• Pediatric Surgery

Background:

• Nerve transfers are established for brachial plexus injuries.
• The long thoracic nerve (LTN) is an underutilized donor for upper extremity reinnervation.
• This study investigates LTN nerve transfers in pediatric brachial plexus palsy.

Purpose of the Study:

• To evaluate the efficacy of the long thoracic nerve (LTN) as a donor in nerve transfers for brachial plexus injuries.
• To identify optimal recipient nerves for LTN nerve transfers.
• To assess outcomes in children with traumatic and birth-related brachial plexus palsies.

Main Methods:

• Retrospective chart review over 10 years at a single institution.
• Included 14 pediatric patients with brachial plexus injuries (10 birth, 4 trauma).
• Primary outcome measure was the active movement scale; average follow-up was 21.3 months (birth) and 10.75 months (trauma).

Main Results:

• Best outcomes observed when LTN was used for obturator nerve reinnervation in free functioning muscle transfers.
• Musculocutaneous and axillary nerves were the next most successful recipients.
• Poor outcomes resulted from transfers to the radial nerve's posterior interosseous fascicles and triceps branches.

Conclusions:

• The LTN is a viable donor for musculocutaneous or axillary nerve reinnervation in primary brachial plexus reconstruction when other donors are unavailable.
• LTN is best utilized for delayed neurotization of free functioning muscle transfers after failed initial reconstruction and donor scarcity.