End-To-Side Nerve Suture in Traumatic Injuries of Brachial Plexus: Review of the Literature and Personal Case Series

Author(s): Battiston B, Artiaco S, Conforti LG, Vasario G, Tos P

Source: J Hand Surg 34E:OnlineFirst, 2009.

Summary:

The authors published their experience with end-to-side nerve coaptations in the treatment of traumatic brachial plexus injuries.  The procedures were performed in 11 patients with incomplete or complete brachial plexus injuries, and in conjunction with standard end-to-end neurotizations.  At a minimum of 2 years after surgery, there was electrodiagnostic study evidence of functioning end-to-side neurotizations in 3 of these cases. 

The authors conclude that end-to-side nerve coaptation is an unreliable substitute for standard reconstructive procedures in brachial plexus injury (i.e, direct nerve repair, nerve grafting, and end-to-end neurotization).  Previous studies of end-to-side neurotization have shown similar mixed results with a predominance of unsuccessful functional recovery (Pienaar et al 2004; Haninec et al 2007).  Nevertheless, the technique may represent a support to standard tactics in cases of severe injury with few undamaged donor nerves. End-to-side nerve suture appears to be ineffective for motor recovery.