Abstract
Objective
Injuries of the upper trunk of the brachial plexus may trigger motor and sensory deficits. There exists a growing body of literature with respect to the reconstruction of motor deficits in upper trunk brachial plexus injuries by using nerve transfers; albeit to date, very few old reports have focused on the reconstruction of sensory loss resulting from upper trunk injuries. In this case series, we review six cases (five males and one female) with upper trunk brachial plexus injuries undergoing sensory nerve transfers.
Methods
Sensory reconstruction was carried out by using transfer of the ulnar to the median nerves, innervating adjacent aspects of the little and ring fingers (the fourth web space) and adjacent aspects of the thumb and the index finger (the first web space), respectively.
Results
The mean age of our six patients was 30.5 ± 9 years old (range 20–45). The mean time interval between the injury and subsequent surgery was 6.6 ± 1.8 months (range 5–10). Five patients achieved S3 or S3+ in both the thumb and the index finger while the sixth one regained S2+ in the index finger while also achieving S3 in the thumb according to the Highet–Zachary system scoring scale.
Conclusion
These results suggest that nerve transfers can achieve satisfactory outcomes in patients having sensory reconstruction after upper brachial plexus injuries, and thus, we lay emphasis on reviving the use of sensory nerve transfer techniques in such patients.
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Acknowledgments
The authors would like to acknowledge the contribution made by Julie Monti Safari, independent English language consultant, for her editing of this manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Guilan University of Medical Sciences) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Comments
A very interesting paper that shows that distal sensory nerve transfers of ulnar to median nerves can restore sensation to functionally important portions of the hand in patients with severe upper trunk brachial plexus injuries.
Michel Kliot
CA, USA
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Emamhadi, M., Andalib, S. Successful recovery of sensation loss in upper brachial plexus injuries. Acta Neurochir 160, 2019–2023 (2018). https://doi.org/10.1007/s00701-018-3648-z
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DOI: https://doi.org/10.1007/s00701-018-3648-z