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Vascularized Ulnar Nerve Graft: 151 Reconstructions for Posttraumatic Brachial Plexus Palsy

Terzis, Julia K. M.D., Ph.D.; Kostopoulos, Vasileios K. M.D.

Plastic and Reconstructive Surgery: April 2009 - Volume 123 - Issue 4 - p 1276-1291
doi: 10.1097/PRS.0b013e31819f2afd
Hand/Peripheral Nerve: Original Articles
Expert

Background: Vascularized nerve grafts were introduced in 1976. Subsequent studies have suggested the superiority of vascularized nerve grafts. In this study, the authors present 23 years’ experience with vascularized ulnar nerve graft. The factors influencing outcomes and a comparison with conventional nerve grafts are presented.

Methods: Between 1981 and 2003, 151 reconstructions with ulnar nerve were performed in 67 patients for brachial plexus injuries. Patients were divided into four groups: those with vascularized ulnar nerve graft from ipsilateral donors, pedicled or free, and those with vascularized ulnar nerve graft from contralateral donors to median nerve or to single motor targets (e.g., axillary, musculocutaneous, triceps) (n = 25, 21, 13, and 8, respectively).

Results: Patients with long denervation times yielded inferior results compared with those operated on early. Pedicle and free ipsilateral ulnar nerve grafts yielded comparable results for biceps muscle neurotization. Neurotization of biceps with a vascularized ulnar nerve graft from the contralateral root was not as effective as neurotization from ipsilateral donors. There was a difference in muscle grading when the target was the median nerve versus single motor targets such as axillary, musculocutaneous, or triceps, but there were no differences between preoperative and postoperative muscle grading of median innervated muscles.

Conclusions: Vascularized ulnar nerve grafting is the appropriate solution for brachial plexus injuries with C8 and T1 root avulsion, with outcomes that are superior to those achieved with conventional nerve grafts. Although few changes have been made over time, the use of ulnar nerve grafts for neurotization of multiple motor targets of the median nerve from contralateral donors is under consideration.

Norfolk, Va.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Microsurgical Program, Eastern Virginia Medical School.

Received for publication August 7, 2008; accepted October 14, 2008.

Disclosure: Neither of the authors has any financial interest or commercial association related to the information presented in this article. There are no conflicts of interest or any funding sources that require disclosure.

Julia K. Terzis, M.D., Ph.D., Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Lewis Hall, Room 2055, 700 Olney Road, Norfolk, Va. 23501, mrc@jkterzis.com

©2009American Society of Plastic Surgeons