Brachial Plexus Injuries with Ulnar Musculocutaneous Transfer: 78 Cases Study Focused on Possible Postoperative Complications

Abstract

Objective To analyze 78 cases of brachial plexus injury submitted to the Oberlin technique between 2003 and 2012. The potential complications of this technique were analyzed, especially motor damage or hypoesthesia of the hand.

Method Medical records from patients with brachial plexus injuries at the levels of the C5-C6 and C5-C6-C7 vertebrae were retrospectively analyzed. Cases submitted to the Oberlin procedure with or without concomitant brachial plexus procedures between 2003 and 2012 were evaluated. The minimum follow-up period was of 1 year. In addition to the clinical examination, electromyography and magnetic resonance imaging (MRI) of the brachial plexus were used to diagnose and locate the nerve damage.

Results A total of 78 surgical patients met the inclusion criteria. Postoperative neurological changes, mostly transient, were observed in 18 patients. Hypoesthesia in the ulnar side of the hand was observed in seven cases; neuropathic pain in five cases; allodynia in four cases, and hand motor loss in two cases.

Conclusion Based on the results of the present case series, we conclude that there are few sequelae in the donor nerve territory compared with the benefit of the Oberlin technique on the recovery of elbow flexion after brachial plexus injuries.

Resumo

Objetivo Analisar 78 casos de lesão de plexo braquial operados, submetidos à técnica de Oberlin entre 2003 e 2012. Possíveis complicações desta técnica foram analisadas, sobretudo possíveis prejuízos motores ou hipoestesia na mão.

Método Foi realizada uma análise retrospectiva de prontuários de pacientes com lesões do plexo braquial com lesão nos níveis das vértebras C5-C6 e C5-C6-C7. Foram analisados casos que haviam sido submetidos ao procedimento de Oberlin associado ou não a outros procedimentos concomitantes do plexo braquial entre 2003 e 2012. O seguimento pós-operatório mínimo foi de 1 ano. Além do exame clínico, foram usadas para o diagnóstico e para a localização da lesão nervosa a eletroneuromiografia e a ressonância nuclear magnética do plexo braquial.

Resultados Foram obtidos 78 casos operados que preenchiam os critérios de inclusão. Alterações neurológicas pós-operatórias foram observadas em 18 pacientes, sendo, em sua grande maioria, transitórias. Hipoestesia na face ulnar da mão foi observada em sete casos; dores neuropáticas, em cinco; alodinia, em quatro; e perda motora na mão, em dois casos.

Conclusão Considerando os resultados da nossa casuística, concluímos que as sequelas no território do nervo doador são poucas diante do benefício que a técnica de Oberlin pode trazer à recuperação da flexão do cotovelo nas lesões do plexo braquial.

Keywords

nerve transfer - ulnar nerve - musculocutaneous nerve

Palavras-Chave

transferência nervosa - nervo ulnar - nervo musculocutâneo

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