• Lukas Rasulić, Andrija Savić, Milan Lepić, Vojin Kovačević, Filip Vitošević, Nenad Novaković, Stefan Mandić-Rajčević, and Miroslav Samardžić.
• Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
• Neurosurgery. 2020 Mar 1; 86 (3): 400-409.

BackgroundIn patients with only upper (C5, C6) brachial plexus palsy (BPP), the pooled international data strongly favor nerve transfers over nerve grafts. In patients with complete BPP, some authors favor nerve grafts for the restoration of priority functions whenever there is a viable proximal stump.ObjectiveTo evaluate functional recovery in cases of upper and complete BPP where only direct graft repair from viable proximal stumps was performed.MethodsThe study included 36 patients (24 with complete BPP and 12 with only upper BPP) operated on over a 15-yr period. In all cases, direct graft repair from C5 to the musculocutaneous and the axillary nerve was performed. In cases with complete BPP, additional procedures included either direct graft repair from C6 to the radial nerve and the medial pectoral nerve or the dorsal scapular nerve transfer to the branch for the long head of the triceps.ResultsThe use of C5 proximal stump grafts (in both complete and upper BPP) resulted in satisfactory elbow flexion in 26 patients (72.2%) and satisfactory shoulder abduction in 22 patients (61.1%). The use of C6 proximal stump grafts in patients with complete BPP resulted in satisfactory elbow extension in 5 (50%) and satisfactory shoulder adduction in another 5 (50%) patients.ConclusionAlthough nerve transfers generally enable better restoration of priority functions, in cases of infraganglionary injuries, especially in shorter defects, it is also necessary to consider direct graft repair, or at least its combination with nerve transfers, as a potentially beneficial treatment modality.Copyright © 2019 by the Congress of Neurological Surgeons.

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