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Comparison of Surgical Strategies between Proximal Nerve Graft and/or Nerve Transfer and Distal Nerve Transfer Based on Functional Restoration of Elbow Flexion: A Retrospective Review of 147 Patients.

Abstract Surgical strategy to treat incomplete brachial plexus injury with palsies of the shoulder and elbow by using proximal nerve graft/transfer or distal nerve transfer is still debated. The aim of this study was to compare both strategies with respect to the recovery of elbow flexion.
PMID
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Authors

Mayor MeshTerms

Nerve Transfer

Range of Motion, Articular

Keywords
Journal Title plastic and reconstructive surgery
Publication Year Start




PMID- 29280873
OWN - NLM
STAT- MEDLINE
DCOM- 20180112
LR  - 20180112
IS  - 1529-4242 (Electronic)
IS  - 0032-1052 (Linking)
VI  - 141
IP  - 1
DP  - 2018 Jan
TI  - Comparison of Surgical Strategies between Proximal Nerve Graft and/or Nerve
      Transfer and Distal Nerve Transfer Based on Functional Restoration of Elbow
      Flexion: A Retrospective Review of 147 Patients.
PG  - 68e-79e
LID - 10.1097/PRS.0000000000003935 [doi]
AB  - BACKGROUND: Surgical strategy to treat incomplete brachial plexus injury with
      palsies of the shoulder and elbow by using proximal nerve graft/transfer or
      distal nerve transfer is still debated. The aim of this study was to compare both
      strategies with respect to the recovery of elbow flexion. METHODS: One hundred
      forty-seven patients were enrolled: 76 patients underwent reconstruction using
      proximal nerve graft/transfer, and 71 patients underwent reconstruction using
      distal nerve transfer. All patients were evaluated preoperatively and
      postoperatively to assess the recovery rate and muscle strength of elbow flexion.
      Shoulder abduction and hand grip power were also recorded to assess any
      concomitant postoperative changes between the two methods. RESULTS: The best
      recovery rate for functional elbow flexion (p = 0.006) and the fastest recovery
      to M3 strength (p < 0.001) were found in the double fascicular transfer group.
      However, recovery of shoulder abduction with proximal nerve graft/transfer was
      significantly better than with distal nerve transfer (80.3 percent versus 66.2
      percent in shoulder abduction >/=60 degrees; and 56.6 percent versus 38.0 percent
      in shoulder abduction >/=90 degrees). A significant decrease in grip strength
      between the operative and nonoperative hands was also found in patients
      undergoing distal nerve transfer (p = 0.001). CONCLUSIONS: Proximal nerve
      graft/transfer offers more accurate diagnosis and proper treatment to restore
      shoulder and elbow function simultaneously. Distal nerve transfer can offer more 
      efficient elbow flexion. Combined, both strategies in primary nerve
      reconstruction are especially recommended when there is no healthy or not enough 
      donor nerve available. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
FAU - Hu, Ching-Hsuan
AU  - Hu CH
AD  - Taoyuan, Taiwan From the Department of Plastic Surgery, Chang Gung Memorial
      Hospital, Chang Gung Medical College and University.
FAU - Chang, Tommy Nai-Jen
AU  - Chang TN
FAU - Lu, Johnny Chuieng-Yi
AU  - Lu JC
FAU - Laurence, Vincent G
AU  - Laurence VG
FAU - Chuang, David Chwei-Chin
AU  - Chuang DC
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Video-Audio Media
PL  - United States
TA  - Plast Reconstr Surg
JT  - Plastic and reconstructive surgery
JID - 1306050
SB  - AIM
SB  - IM
MH  - Adult
MH  - Brachial Plexus/*injuries/surgery
MH  - Elbow Joint/*physiology
MH  - Female
MH  - Follow-Up Studies
MH  - Hand Strength
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Nerve Transfer
MH  - Peripheral Nerve Injuries/*surgery
MH  - *Range of Motion, Articular
MH  - Recovery of Function
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2017/12/28 06:00
MHDA- 2018/01/13 06:00
CRDT- 2017/12/28 06:00
PHST- 2017/12/28 06:00 [entrez]
PHST- 2017/12/28 06:00 [pubmed]
PHST- 2018/01/13 06:00 [medline]
AID - 10.1097/PRS.0000000000003935 [doi]
AID - 00006534-201801000-00026 [pii]
PST - ppublish
SO  - Plast Reconstr Surg. 2018 Jan;141(1):68e-79e. doi: 10.1097/PRS.0000000000003935.