Secondary surgery following brachial plexus injuries

The favourable treatment of post-traumatic brachial plexus lesions based on our experience of 362 cases over a 12 year period is reported. Twenty-five percent of the patients needed secondary operations. The spectrum of the latter consisted of arthrodesis, tenodesis, and musculotendinous transfer, including free neurovascular tissue transfer partially innervated by nerve transposition. Functionally, secondary tendon transfer can help to improve the effect of nerve repair techniques. To restore shoulder function the trapezius transfer (n = 22) has been used mainly; elbow flexion has been regained by pedicled latissimus dorsi translocation (n = 22), triceps-to-biceps transfer (n = 18), bipolar latissimus muscle transfer, and free neurovascular tissue transfer (n = 8). The Steindler flexorplasty was performed in four plexopathies, and finally a pedicled serratus muscle transfer was used. A unipolar latissimus dorsi transfer results in an ability to lift 10-15 kg, whilst the bipolar latissimus transfer and the triceps-to-biceps transfer produced a maximal strength of 5-8 kg. Epitrochlear flexor-pronator mass transfer produced a strength of 2-5 kg, whereas free neurovascular latissimus dorsi transfer developed a maximal muscular strength of 2-4 kg in the unipolar variation and 1-2 kg for the bipolar LD. In 97 secondary procedures to the lower arm and hand the following secondary operations were indicated: in 29 cases of radial nerve palsy transfers according to Merle d'Aubigne, a further 21 wrist tenodeses and 8 wrist arthrodeses were performed. To restore median nerve function, coupling tendon transfer (n = 4) and free neurovascular gracilis transfer (n = 3) were selected.(ABSTRACT TRUNCATED AT 250 WORDS)