Outcomes of neonatal brachial plexus reconstruction using the supraclavicular nerve as a donor graft

Interposition nerve grafting is widely used for reconstructing neonatal brachial plexus palsy (NBPP). While the sural nerve graft has historically been the gold standard, the supraclavicular nerve offers the advantage of plentiful donor nerve graft within the operative field. This study reports the outcomes of using supraclavicular nerve grafts for NBPP reconstruction.

A retrospective review was conducted on the medical records of patients with NBPP who underwent supraclavicular nerve grafting at the authors' institution between January 2011 and January 2023. Patients with a minimum of 18 months of follow-up were included. Demographic characteristics, injury location, surgical details, preoperative and postoperative Active Movement Scale (AMS) scores, and additional therapies were recorded.

Thirty-three patients met the inclusion criteria. Reconstruction was performed at a median of 9.7 [IQR 5.9, 17.8] months of age. The majority of patients (87.9%) had upper trunk injuries, primarily affecting the right brachial plexus (69.7%). The mean operative time was 5.48 ± 1.2 hours. At a median follow-up of 25.5 months, > 60% of patients achieved initial motor recovery (> 2-point AMS improvement) in shoulder and elbow flexion, and > 50% of patients achieved antigravity motor function (AMS score ≥ 5) in most, but not all, movements. Patients operated on after 12 months had less favorable outcomes, including reduced movement in some cases. The complication rate was low, with 2 wound infections (6.1%) and 1 case of transient elevated hemidiaphragm (3.0%).

The supraclavicular nerve graft is an effective donor for NBPP reconstruction, providing favorable motor recovery and antigravity strength. The timing of surgery plays a crucial role in optimizing functional outcomes, with earlier repairs showing the best results. Secondary procedures may be performed to maximize functional recovery.