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Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury

O’Grady, Kathleen M., M.Sc.; Power, Hollie A., M.D.; Olson, Jaret L., M.D.; Morhart, Michael J., M.Sc., M.D.; Harrop, A. Robertson, M.D.; Watt, M. Joe, M.D.; Chan, K. Ming, M.D.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 747-756
doi: 10.1097/PRS.0000000000003668
Hand/Peripheral Nerve: Original Articles
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Background: Upper trunk obstetric brachial plexus injury can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and health care costs between nerve grafting and distal nerve transfers in children with upper trunk obstetric brachial plexus injury.

Methods: In this prospective cohort study, children who underwent triple nerve transfers were followed with the Active Movement Scale for 2 years. Their outcomes were compared to those of children who underwent nerve graft reconstruction. To assess health care use, a cost analysis was also performed.

Results: Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years after surgery (p < 0.05). The operative time and length of hospital stay were significantly lower (p < 0.05), and the overall cost was approximately 50 percent less in the nerve transfer group.

Conclusion: Triple nerve transfer for upper trunk obstetric brachial plexus injury is a feasible option, with better functional shoulder external rotation and forearm supination, faster recovery, and lower cost compared with traditional nerve graft reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Edmonton and Calgary, Alberta, Canada

From the Department of Occupational Therapy, Glenrose Rehabilitation Hospital; the Division of Plastic Surgery, the Department of Pediatrics, Faculty of Medicine, and the Division of Physical Medicine and Rehabilitation, University of Alberta; and the Division of Plastic Surgery, University of Calgary.

Received for publication September 12, 2016; accepted March 3, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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K. Ming Chan, M.D., Division of Physical Medicine and Rehabilitation, 5005 Katz Group Centre, University of Alberta, 11361-87 Avenue, Edmonton, Alberta T6G 2E1, Canada, ming.chan@ualberta.ca

Copyright © 2017 by the American Society of Plastic Surgeons