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[Nerve and muscle transfer surgery to restore paralyzed elbow function]

Journal article
Authors A. Gohritz
Jan Fridén
M. Spies
C. Herold
M. Guggenheim
K. Knobloch
P. M. Vogt
Published in Unfallchirurg
Volume 111
Issue 2
Pages 85-101
ISSN 0177-5537 (Print)
Publication year 2008
Published at Institute of Clinical Sciences
Pages 85-101
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Brachial Plexus/*injuries/surgery, Elbow Joint/*innervation, Humans, Muscle Strength/physiology, Muscle, Skeletal/*innervation/*transplantation, Nerve Regeneration/physiology, Nerve Transfer/*methods, Paresis/*surgery, Peripheral Nerves/transplantation, Peripheral Nervous System Diseases/*surgery, Postoperative Care, Range of Motion, Articular/physiology
Subject categories Hand surgery

Abstract

Paralysis of elbow flexion or extension leads to major impairment of upper extremity function. Surgical reconstruction can be achieved using several procedures.If the time interval since the nerve injury is short, anatomic reconstruction by means of nerve suture or nerve transplantation should be attempted. Alternatively, nerve transposition is possible. If more than 12-18 months have elapsed, reinnervation of arm muscles can no longer be expected. In this case, muscle transposition is helpful. Restoring flexion is predominantly required following brachial plexus injury, when the function of the biceps, brachioradialis and brachialis muscles are lost. As donor muscles the latissimus dorsi, pectoralis major and triceps brachii can be used, alternatively a transfer of the flexor-pronator muscles of the forearm is possible. Latissimus dorsi transfer to reconstruct elbow flexion is also indicated in defects of the anterior upper arm muscle compartiment due to trauma, ischemia, or tumor. Patients with proximal radial nerve lesions may benefit from latissimus transfer to reachieve elbow flexion extension.In tetraplegic patients, elbow extension is restored mainly by transfer of the posterior deltoid muscle extended with a tendon graft, or by means of a biceps-to-triceps transfer.

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