Priyadarshini Cirumanur Subramaniam1 , Jeyakumar Periakaruppan2
BACKGROUND Incidence of total brachial plexus-avulsion injury is on the increase and is difficult to treat. The consequences are devastating resulting in significant disability. We wanted to compare rehabilitation outcome of Spinal Accessory Nerve Transfer (SANT) to Musculocutaneous Nerve (MCN) with Intercostal Nerve Transfer (ICNT) to Musculocutaneous Nerve for restoring elbow flexion in traumatic total brachial plexus injury. METHODS This is a cross sectional study performed in 30 traumatic total brachial plexus injury patients at Institute of Research and Rehabilitation of Hand, Stanley Medical College, Chennai, between January 2018 and December 2019. 15 of them underwent spinal accessory nerve transfer (SANT) to musculocutaneous nerve and 15 patients underwent intercostal nerve transfer (ICNT) to musculocutaneous nerve (MCN). Post-surgery, patients were enrolled in a structured rehabilitation program with periodic follow up and assessment of biceps muscle power was performed. RESULTS 9 out of 15 (60%) patients regained biceps muscle power 3 or more in SANT group as compared to 5 out of 15 patients (33.3%) in the ICNT group. Mean time duration for clinical reinnervation of biceps in SANT and ICNT groups were 6.1 and 9.4 months respectively which was not statistically significant. Biceps muscle score at the end of the follow up period was 3 ± 0.82 in SANT group and 2.3± 0.95 in ICNT group which was statistically significant (by Mann-Whitney nonparametric U test, U value =63.4, p<0.05). CONCLUSIONS SANT group regained greater final biceps muscle power score but there was no statistically significant difference in the rates of effective recovery between the two groups and hence we conclude that both of the procedures are equally efficacious.
