2006 - UZ Leuven

Background: Within the last decade contralateral C7-Transfer hasbecome a new source of axon donor in complete brachial plexuslesions.Patients and methods: Between 1995 and 2001 10 adult patient weretreated. If possible the vascularized ulnar nerve graft or if not availabletwo sural nerves were used. Neurotization of the musculocutaneous(MC) nerve was carried out in six patients and in four patients of themedian nerve. There were six patients in the MC group and fourpatients in the median nerve group with more than 3 years of followup.Criteria for evaluation were, donor site morbidity, classification,time for recovery, time for autonomization, and functional result.Successful elbow flexion is achieved if muscle power > M3, successfulmedian nerve motor function is achieved if a primitive power grippattern is achieved.Results: All patients were complaining of temporary paresthesia in thedorsal part of P2 of the thumb and P3 of index and middle finger.There was complete sensory recovery at the 3 month postoperatively.There was no clinical evident motor loss at the donor extremity. Asuccessful elbow flexion, i.e. muscle power > M3 was achieved in allsix patients after 9 to 15 months. Four of six patients are able to usethis function individually. In the other two patients a start commandmust be given volontarily from the contralateral side (contraction of thecontralateral latissimus dorsi muscle). A functional primitive grippattern could be achieved in one out of four patients after 18 months.In three patients although there was movement this movement had tobe judged “academic” at the present state.Conclusion: The C7-transfer proved to be a save transfer if at the timeof operation no fascicles innervating wrist and finger extension aretaken. Adequate biceps muscle function was provided with activeelbow flexion in most patienst. However for median nervereinnervation motor results are moderate up to now.HIERNER R., BERGER A.: Free functional muscle transfer inposttraumatic brachial plexus lesions: is it worthwhile? J. Hand Surg.,2006; 31B: 29.Background: Free functional muscle transfer is indicated in brachialplexus lesions for reconstruction of basic functions at the elbow andhand level, if the neural reconstruction and eventual secondaryprocedures did not lead to a satisfactory result.Patients and method: In a retrospective clinical study 29 patients witha free functional muscle transfer after brachial plexus lesion with afollow-up of more than 3 years were examined. In 8 patients elbowflexion (direct intercostal transfer to gracilis (n = 4) or latissimus dorsi(n = 4)), in 16 patients wrist and finger flexion (intercostal transfer to78