Preservation of Intrinsic Muscle Function in Root Injury of the Brachial Plexus by Suturing the Median and Ulnar Nerves to the Femoral Nerve

Abstract

In five cases of total root avulsion injury of brachial plexus, the thenar branch of the median nerve and the deep branch of the ulnar nerve were sutured to the branches of the femoral nerve during the procedure of intercostal, phrenic, accessory nerve transfer to the nerve trunks. The suture of the distal median or ulnar nerve in the hand to the femoral nerve was to maintain intrinsic muscles and prevent their atropy before arrival of nerve regeneration from the proximal end. The suture of the nerves was protected by wrapping it by abdominal flaps. The median and the ulnar nerve branches were separated from the femoral nerve when the NAP or SEP became detectable (about 1.5 years after the initial surgery). Good function of intrinsic muscles of the hand was observed in these five cases during the course of follow-up of the initial surgery, but the nerve recovery was not good after resuture of the median and the ulnar nerves. It was suggested from this preliminary clinical observation that suture of the distal median and ulnar nerves with the other nerves is effective in preservation of intrinsic muscle function, but recovery of intrinsic muscle function by resuture of the median and the ulnar nerves is not good.