Free muscle transplantation combined with intercostal nerve crossing for reconstruction of elbow flexion and wrist extension in brachial plexus injuries.

Complete paralysis due to traumatic brachial plexus injury is extremely difficult to treat when the injury affects whole nerve roots and when motor function fails to show any signs of recovery. Seddon has suggested that arthrodesis of the shoulder and amputation at the humerus, combined with the use of a functional upper extremity prosthesis, was the most practical procedure available. Since 1965, in cases of irreparable lesions such as complete root avulsion type injuries, we have performed direct intercostal nerve crossing to the musculocutaneous nerve without free nerve graft to achieve elbow flexion. However, it is necessary to operate on the patient within 6 months following the injury to obtain good results. In the past there was no procedure for dealing with delayed cases of complete brachial plexus palsy. However, with the advent of microsurgical techniques, new approaches have become open to us. Since 1978, we have reconstructed the elbow flexor by the combined surgery of free muscle transplantation with intercostal nerve crossing in delayed cases of complete paralysis. This article introduces the operative technique and the results we have obtained.