Median and/or Ulnar Nerve Fascicle Transfer for the Restoration of Elbow Flexion in Upper Neonatal Brachial Plexus Palsy.

Overview

INTRODUCTION: Transfer of a fascicle of the ulnar and/or median nerve to the musculocutaneous nerve in order to reinnervate the biceps and/or brachialis muscles has a high success rate and a low rate of complications in infants with upper (C5-C6) or extended upper (C5-C7) neonatal brachial plexus palsy. STEP 1 MAKE THE INCISION: Make a longitudinal incision along the midline of the middle third of the medial brachium. STEP 2 MOBILIZE THE MUSCULOCUTANEOUS NERVE: The musculocutaneous nerve is typically found on the undersurface of the biceps muscle. STEP 3 MOBILIZE THE MEDIAN NERVE: The median nerve runs along the neurovascular sheath medial to the brachial artery. STEP 4 MOBILIZE THE ULNAR NERVE: The ulnar nerve lies posterior to the intermuscular septum. STEP 5 TRANSFER THE DONOR NERVE TO THE RECIPIENT NERVE: Cut the donor fascicles distally and the recipient fascicles proximally to facilitate transfer. STEP 6 CLOSE THE WOUND: Irrigate the wound, and close it in layers. STEP 7 POSTOPERATIVE PROTOCOL: Remove the bandages two weeks postoperatively, and encourage passive range-of-motion exercises. RESULTS: In our series, thirty-one patients underwent single or combined nerve fascicle transfer; twenty-seven (87%) obtained functional elbow flexion recovery (Active Movement Scale [AMS] score ≥ 6) while twenty-four (77%) obtained full elbow flexion recovery (AMS score = 7). Indications Contraindications Pitfalls & Challenges.