Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor

Foroni, Luciano; Siqueira, Mário Gilberto; Martins, Roberto Sérgio; Heise, Carlos Otto; Sterman, Hugo; Imamura, Adriana Yoriko

doi:10.1590/0004-282X20170148

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Article • Arq. Neuro-Psiquiatr. 75 (11) • Nov 2017 • https://doi.org/10.1590/0004-282X20170148 copy

Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor

Boa recuperação da sensibilidade da mão usando o nervo intercostobraquial como doador em cirurgia do plexo braquial

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Restoration of the sensitivity to sensory stimuli in complete brachial plexus injury is very important. The objective of our study was to evaluate sensory recovery in brachial plexus surgery using the intercostobrachial nerve (ICBN) as the donor.

Methods:

Eleven patients underwent sensory reconstruction using the ICBN as a donor to the lateral cord contribution to the median nerve, with a mean follow-up period of 41 months. A protocol evaluation was performed.

Results:

Four patients perceived the 1-green filament. The 2-blue, 3-purple and 4-red filaments were perceptible in one, two and three patients, respectively. According to Highet's scale, sensation recovered to S3 in two patients, to S2+ in two patients, to S2 in six patients, and S0 in one patient.

Conclusion:

The procedure using the ICBN as a sensory donor restores good intensity of sensation and shows good results in location of perception in patients with complete brachial plexus avulsion.

Keywords:
brachial plexus; intercostal nerves; median nerve; nerve transfer; sensation; perception

Case number	Highet's scale	Monofilament detected	Location of perception	Vibration perception	Temperature perception	Two-point discrimination
2	S2	3-purple	arm	(+)	(+)	(-)
3	S2	2-blue	arm	(+)	(+)	(-)
9	S2	4-red	hand	(-)	(+)	(-)
10	S2	4-red	hand	(-)	(+)	(-)
11	S2	3-purple	arm	(+)	(+)	(-)
12	S2+	1-green	hand	(+)	(+)	(-)
13	S2	4-red	hand	(-)	(+)	(-)
14	S3	1-green	hand	(+)	(+)	(-)
16	S2+	1-green	hand	(+)	(+)	(-)
17	S0	black	(-)	(-)	(-)	(-)
18	S3	1-green	Hand and arm	(+)	(+)	(-)

Author(s), year	Number of patients / donor(s)	Results
Kotani et al., 1971¹¹11. Kotani T, Toshima Y, Matsuda H, Suzuki T, Ishizaki Y. Postoperative results of nerve transposition in brachial plexus injury. Seikeigeka. 1971;22(11):963-6.	15 / ICNs	Limited sensitivity in 11 patients
Millesi, 1977¹²12. Millesi H. Surgical management of brachial plexus injuries. J Hand Surg. 1977;2(5):367-78. https://doi.org/10.1016/S0363-5023(77)80046-4 https://doi.org/10.1016/S0363-5023(77)80...	18 / grafts or ICNs	Protective sensitivity in 15 patients
Narakas and Hentz, 1988¹³13. Narakas AO, Hentz VR. Neurotization of brachial plexus injuries: indication and results. Clin Orthop. 1988;(237):43-56.	9 / ICNs	“Good recovery” in 4 patients
Sedel, 1982¹⁴14. Sedel L. Repair of severe traction lesion of the brachial plexus. ClinOrthop.1988;(237):62-3.	22 / grafts or ICNs	S1 in 14 patients
Kawai et al., 1988¹⁵15. Kawai H, Kawabata H, Masada K, Ono K, Yamamoto K, Tsuyuguchi Y, Tada K. Nerve repairs for traumatic brachial plexus palsy with root avulsion. Clin Orthop Relat Res.1988;(237):75-86.	13 / ICNs	S2 in 5 patients
Nagano et al., 1989¹⁶16. Nagano A, Tsuyama N, Ochiai N, Hara T, Takahashi T. Direct nerve crossing with the intercostal nerve to treat avulsion injuries to the brachial plexus. J Hand Surg Am.1989;14(6):980-5. https://doi.org/10.1016/S0363-5023(89)80047-4 https://doi.org/10.1016/S0363-5023(89)80...	4 / ICNs	Protective sensitivity in 4 patients
Ogino e Naito, 1995¹⁷17. Ogino T, Naito T. Intercostal nerve crossing to restore elbow flexion and sensibility of the hand for a root avulsion type of brachial plexus injury. Microsurgery.1995;16(8):571-7. https://doi.org/10.1002/micr.1920160812 https://doi.org/10.1002/micr.1920160812...	10 / ICNs	Protective sensitivity in 10 patients
Ihara et al., 1996¹⁸18. Ihara K, Doi K, Sakai K, Kuwata N, Kawai S. Restoration of sensibility in the hand after complete brachial plexus injury. J Hand Surg. 1996;21(3):381-6. https://doi.org/10.1016/S0363-5023(96)80348-0 https://doi.org/10.1016/S0363-5023(96)80...	13 / ICNs in 3 and SCN in 10	S2 in 3 patients using ICNs and S2 in 2 patients using SCN
Gu et al., 1998¹⁹19. Gu YD, Chen DS, Zhang GM, Cheng XM, Xu JG, Zhang LY et al. Long-Term functional results of contralateral C7 transfer. J Reconstr Microsurg.1998;14(1):57-9.	8 / CC7	S3 in 6 patients
Songchaoren et al., 2001²⁰20. Songcharoen P Wongtrakul S, Mahaisavariya B, Spinner RJ. Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury. J Hand Surg Am.2001;26(6):1058-64. https://doi.org/10.1053/jhsu.2001.27764 https://doi.org/10.1053/jhsu.2001.27764...	21 / CC7	S3 in 10 patients, S2 in 7 patients
Chen et al., 2007²¹21. Chen L, Gu YD, Hu SN, Xu JG, Xu L, Fu Y. Contralateral C7 transfer for the treatment of brachial plexus root avulsions in children: a report of 12 cases. J Hand Surg Am.2007;32(1):96-103. https://doi.org/10.1016Zj.jhsa.2006.05.013 https://doi.org/10.1016Zj.jhsa.2006.05.0...	12 children / CC7	S3+ in 6 patients, S3 in 6 patients
Terzis et al., 2008²²22. Terzis JK, Kokkalis ZT, Kostopoulos E. Contralateral C7 transfer in adult plexopathies. Hand Clin.2008;24(4):389-400. https://doi.org/10.1016/j.hcl.2008.04.003 https://doi.org/10.1016/j.hcl.2008.04.00...	29 / CC7	S3 in 12 patients, S2 in 10 patients
Hattori et al., 2009¹⁰10. Hattori Y, Doi K, Sakamoto S, Yukata K. Sensory recovery of the hand with intercostal nerve transfer following complete avulsion of the brachial plexus. Plast Reconstr Surg. 2009;123(1):276-83. https://doi.org/10.1097/PRS.0b013e31819348a7 https://doi.org/10.1097/PRS.0b013e318193...	17 / ICNs and/or ICBN	S2+ in 2 patients, S2 in 9 patients, S1 in 6 patients
Gao et al., 2013²³23. Gao K, Lao J, Zhao X, Gu Y. Outcome of contralateral C7 transfer to two recipient nerves in 22 patients with the total brachial plexus avulsion injury. Microsurgery.2013;33(8):605-11. https://doi.org/10.1002/micr.22137 https://doi.org/10.1002/micr.22137...	22 / CC7	S3 in 10 patients
El-Gammal et al., 2014²⁴24. El-Gammal TA, El-Sayed A, Kotb MM, Saleh WR, Ragheb YF, El-Refai O. Delayed selective neurotization for restoration of elbow and hand functions in late presenting obstetrical brachial plexus palsy. J Reconstr Microsurg.2014;30(4):271-4. https://doi.org/10.1055/s-0033-1357280 https://doi.org/10.1055/s-0033-1357280...	5 children / ICNs or CC7	S2 in 5 patients

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[1] Correspondence: Luciano Foroni; Rua Mateus Grou, 340 / apto. 22; 05415-040 São Paulo SP, Brasil; E-mail: lucianoforoni@yahoo.com.br