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Background: Using grafts directed to distal targets in brachial plexus reconstruction has the advantage over proximal targets of avoiding axonal dispersion. A long graft (more than 10 cm) is needed to reach most distal targets. The objective of this article is to identify factors associated with good versus poor outcomes in a clinical series of long grafts used for distal brachial plexus reconstruction. Methods: In 34 patients with a flail arm, 47 sural grafts>10 cm long were followed for≥2 years postoperatively. Surgical technique included standard supraclavicular exposure of the proximal brachial plexus and its branches, the phrenic nerve and spinal accessory nerve. Distal target nerves were exposed via an incision starting at the axilla, following the gap between the biceps and triceps. Cases achieving a good result were statistically compared against those with a poor result as to the donor nerve/root, target nerve, patient age and weight, time from trauma to surgery, graft length and long-term rehabilitation quality. Findings: A good outcome was observed with 23 grafts (48.9%), but 66.7% of the 30 long grafts done within 6 months of trauma yielded a good result. Only 1 of 15 patients with the lowest quality rehabilitation score experienced a good result (6.6%) versus all 12 patients with the highest rating (p<0.001). Trauma-to-surgery time was roughly half as long in those with a good result (4.7 vs. 9.0 months, p<0.001). No other inter-group differences were observed. Conclusions: The results of a series of distal brachial plexus target reinnervations with long grafts is presented and analyzed. According to them, time from trauma to surgery and an adequate postoperative rehabilitation are important predictors of outcome. © 2011 Springer-Verlag.


Documento: Artículo
Título:Use of long autologous nerve grafts in brachial plexus reconstruction: Factors that affect the outcome
Autor:Socolovsky, M.; Di Masi, G.; Battaglia, D.
Filiación:Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, Buenos Aires 1428, Argentina
Department of Rehabilitation and Physiotherapy, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
Palabras clave:Brachial plexus injury; Long nerve grafts; Nerve reconstruction; Nerve transfers; Sural nerve grafts; adult; age; article; axilla; biceps brachii muscle; body weight; brachial plexus injury; clinical article; controlled study; disease duration; donor; female; follow up; health care quality; human; long term care; male; nerve; nerve graft; nerve surgery; phrenic nerve; priority journal; skin incision; spinal accessory root; sural nerve; surgical technique; treatment outcome; triceps brachii muscle; Adolescent; Adult; Brachial Plexus; Brachial Plexus Neuropathies; Humans; Male; Nerve Transfer; Reconstructive Surgical Procedures; Retrospective Studies; Sural Nerve; Transplantation, Autologous; Young Adult
Página de inicio:2231
Página de fin:2240
Título revista:Acta Neurochirurgica
Título revista abreviado:Acta Neurochir.


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---------- APA ----------
Socolovsky, M., Di Masi, G. & Battaglia, D. (2011) . Use of long autologous nerve grafts in brachial plexus reconstruction: Factors that affect the outcome. Acta Neurochirurgica, 153(11), 2231-2240.
---------- CHICAGO ----------
Socolovsky, M., Di Masi, G., Battaglia, D. "Use of long autologous nerve grafts in brachial plexus reconstruction: Factors that affect the outcome" . Acta Neurochirurgica 153, no. 11 (2011) : 2231-2240.
---------- MLA ----------
Socolovsky, M., Di Masi, G., Battaglia, D. "Use of long autologous nerve grafts in brachial plexus reconstruction: Factors that affect the outcome" . Acta Neurochirurgica, vol. 153, no. 11, 2011, pp. 2231-2240.
---------- VANCOUVER ----------
Socolovsky, M., Di Masi, G., Battaglia, D. Use of long autologous nerve grafts in brachial plexus reconstruction: Factors that affect the outcome. Acta Neurochir. 2011;153(11):2231-2240.