Nerve Repair and Nerve Grafting in Brachial Plexus Injuries

Tae Kyoon Lee; Jun O Yoon; Young Ho Shin; Jae Kwang Kim

doi:10.12790/jkssh.2017.22.3.147

Journal List > J Korean Soc Surg Hand > v.22(3) > 1106565

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Lee, Yoon, Shin, and Kim: Nerve Repair and Nerve Grafting in Brachial Plexus Injuries

Review Article

Journal of the Korean Society for Surgery of the Hand 2017; 22(3): 147-153.

Published online: 26 September 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.3.147

Nerve Repair and Nerve Grafting in Brachial Plexus Injuries

Tae Kyoon Lee, Jun O Yoon, Young Ho Shin, Jae Kwang Kim

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Jae Kwang Kim. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic road 43-gil, Songpa-gu, Seoul 05505, Korea. TEL: +82-2-3010-3523, FAX: +82-2-3010-8555, orth4535@gmail.com

Received 3 August 2017 Revised 30 August 2017 Accepted 30 August 2017

The Korean Society for Surgery of the Hand

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Brachial plexus injuries (BPI) can have devastating effects on upper extremity function, however, treatment in this injuries remains a difficult problem. Several kinds of surgical methods have been used to treat BPI, and nerve repair and nerve grafting have been traditionally used in postganglionic injury of brachial plexus. Because the several studies reported that nerve transfer to restore shoulder and elbow function has yielded superior results to historical reports for nerve grafting in partial BPI, the indication of nerve repair and nerve grafting has been decreased. Nonetheless, nerve repair and nerve grafting is still useful in focal damage in brachial plexus, such as laceration or gunshot wound and postganglionic neuroma in continuity without conduction of nerve action potential. In this paper, we described the basic concept, detailed indication and outcomes of nerve repair or nerve grafting in BPI.

Keywords: Brachial plexus injuries, Nerve graft

Figures and Tables

Fig. 1

The supraclavicular brachial plexus and the spinal nerve can be exposed through the transverse skin incision in the proximal portion of the clavicle (white arrow), and the deltopectoral approach allows the infraclavicular brachial plexus to be exposed (black arrow).

Fig. 2

In supraclavicular approach, omohyoid muscle (asterisk) was exposed after incision of the platysma and cervical fat pad.

Fig. 3

Upper trunk (asterisk) was exposed after incision of omohyoid muscle.

Fig. 4

About 4 cm nerve defect (A) was treated with cabled sural nerves graft (B).

Fig. 5

Sural nerve graft. (A) Skin incision for harvesting sural nerve. (B) Harvested sural nerve.

Fig. 6

Harvested vascularized ulnar nerve.

Notes

^{CONFLICT OF INTEREST} No potential conflict of interest relevant to this article was reported.

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