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Intercostal nerve transfer in infants with obstetric brachial plexus palsy
Author(s) -
ElGammal Tarek A.,
AbdelLatif Mohamed M.,
Kotb Mohamed M.,
ElSayed Amr,
Ragheb Yasser Farouk,
Saleh Waleed Riad,
Geith Mohamed A.,
AbdelGhaffar Hala S.
Publication year - 2008
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.20545
Subject(s) - medicine , brachial plexus injury , brachial plexus , surgery , intercostal nerves , atelectasis , palsy , anesthesia , lung , alternative medicine , pathology
The use of intercostal nerve (ICN) transfer to repair brachial plexus lesions associated with root avulsions is a well known procedure in adults. However, there is a paucity of reports on the use of ICN in infants with obstetrical brachial plexus palsy (OBPP). This study included 46 infants with obstetric brachial plexus palsy who underwent 62 neurotization procedures. Clinically, 2 cases had upper trunk injury, 19 had upper‐middle trunk injury, 3 had lower trunk injury, and 22 had total palsy. The average age at surgery was 14 months. Twelve patients underwent surgery younger than 6 months of age, 11 patients at 6 to <9 months, 9 patients at 9–12 months, and 14 patients at >12 months. The average follow‐up period was 49 months. ICN transfer resulted in 76% satisfactory (good and excellent) outcome, and was best for restoration of elbow flexion (93.5%). Functional results were best when the operation was done before the age of 9 months; however, the difference between age groups was statistically insignificant. Functional results were also independent of the extent of the original injury. Nine children had preoperative and postoperative CT chest scans. All the nine children developed basal pulmonary atelectasis postoperatively. Pulmonary atelectasis was mostly ipsilateral and was not correlated to the patient age (months), or the duration of anesthesia (in minutes). We conclude that, intercostals nerve transfer is an effective procedure for restoration of function in infants with OBPP and root avulsions. The procedure is associated with variable degree of ipsilateral pulmonary atelectasis. © 2008 Wiley‐Liss, Inc. Microsurgery, 2008.