Yavari Masoud, Mahmoudvand Hormoz, Nadri Sedigheh, Rouientan Abdolreza
Department of Plastic and Reconstructive Surgery, 15 Khordad Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology, Lorestan University of Medical Sciences, Khorramabad, Iran.
J Surg Res. 2018 Nov;231:94-98. doi: 10.1016/j.jss.2018.05.021. Epub 2018 Jun 12.
There is a very small chance of success for nerve reconstruction in patients with old total brachial plexus palsy who visit after 2 y or suffer from flail upper extremity after the failure of previous operations.
For these individuals, the surgeon has to find a recipient motor nerve to perform free gracilis muscle transplantation. In this study, contralateral medial pectoral nerve from the intact side was transferred to the damaged side as a recipient nerve. Then, in the second operation, approximately 15 mo later, the free gracilis muscle transfer was performed. The gracilis muscle was removed and transferred to provide elbow and finger flexion.
In a retrospective study (over 10 y), we reviewed 68 patients for whom this method had been performed. After 1 y, the results were investigated using the Medical Research Council grading system. Five patients did not participate in the study, and the muscle underwent necrosis in two patients. M3 and M4 muscle power was regained in 26 (42.6%) and 21 (34.4%) patients, respectively.
Contralateral pectoral nerve transfer followed by free muscle transplantation can be a good option for patients with old total brachial plexus palsy.
对于就诊时间超过2年的陈旧性全臂丛神经麻痹患者或既往手术失败后出现连枷上肢的患者，神经重建成功的机会非常小。
对于这些患者，外科医生必须找到一条受区运动神经来进行游离股薄肌移植。在本研究中，将来自健侧的对侧胸内侧神经作为受区神经转移至患侧。然后，在大约15个月后的第二次手术中，进行游离股薄肌移植。切取并转移股薄肌以提供肘关节和手指屈曲功能。
在一项回顾性研究（超过10年）中，我们对68例接受该方法治疗的患者进行了评估。1年后，使用医学研究理事会分级系统对结果进行调查。5例患者未参与研究，2例患者肌肉发生坏死。分别有26例（42.6%）和21例（34.4%）患者恢复到M3和M4肌力。
对侧胸神经转移联合游离肌肉移植对于陈旧性全臂丛神经麻痹患者可能是一个不错的选择。
