Intercostal to musculocutaneous nerve transfer in patients with complete traumatic brachial plexus injuries: case series.
BACKGROUND
To recover biceps strength in patients with complete brachial plexus injuries, the intercostal nerve can be transferred to the musculocutaneous nerve. The surgical results are very controversial, and most of the studies with good outcomes and large samples were carried out in Asiatic countries. The objective of the study was to evaluate biceps strength after intercostal nerve transfer in patients undergoing this procedure in a Western country hospital.


METHODS
We retrospectively analyzed 39 patients from 2011 to 2016 with traumatic brachial plexus injuries receiving intercostal to musculocutaneous nerve transfer in a rehabilitation hospital. The biceps strength was graded using the British Medical Research Council (BMRC) scale. The variables reported and analyzed were age, the time between trauma and surgery, surgeon experience, body mass index, nerve receptor (biceps motor branch or musculocutaneous nerve), and the number of intercostal nerves transferred. Statistical tests, with a significance level of 5%, were used.


RESULTS
Biceps strength recovery was graded ≥M3 in 19 patients (48.8%) and M4 in 15 patients (38.5%). There was no statistical association between biceps strength and the variables. The most frequent complication was a pleural rupture.


CONCLUSIONS
Intercostal to musculocutaneous nerve transfer is a safe procedure. Still, biceps strength after surgery was ≥M3 in only 48.8% of the patients. Other donor nerve options should be considered, e.g., the phrenic or spinal accessory nerves.
['de Mendonça Cardoso|Marcio|M|0000-0002-3031-7725', 'Gepp|Ricardo|R|', 'Lima|Flávio Leão|FL|', 'Gushiken|Andreia|A|']
D000055:Accessory Nerve D000328:Adult D001917:Brachial Plexus D020516:Brachial Plexus Neuropathies D005260:Female D006801:Humans D007367:Intercostal Nerves D008297:Male D008875:Middle Aged D018482:Muscle, Skeletal D009138:Musculocutaneous Nerve D016067:Nerve Transfer D011183:Postoperative Complications
Musculocutaneous nerve Nerve transfer Brachial plexus Intercostal nerve