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Sunday, September 25, 2016: 10:55 AM
Purpose: There is little consensus regarding the best method for reconstructing peripheral nerve injuries not amenable to primary repair. The purpose of this study is to compare functional outcomes between nerve grafting and nerve transfer procedures in the setting of isolated, post-traumatic axillary nerve injuries.
Methods: A systematic review was performed using the PubMED, SCOPUS, and Cochrane databases in order to identify all cases of isolated, post-traumatic axillary nerve injuries in patients 18 years or older. Patients who underwent axillary nerve reconstruction were included and categorized by technique: graft or transfer. Demographics were recorded, as well as concomitant injuries. Functional outcomes were compared, including British MRC strength and range of motion.
Results: Twelve retrospective studies met criteria, for a total of 66 patients (19 nerve grafts, 47 nerve transfers). Median time from injury to operation was equivalent across the nerve graft and nerve transfer groups (6.9 months versus 7.3 months; P=0.546). Postoperative follow-up was 12 months for patients who underwent nerve grafting versus 18 months those who had transfers (P=0.022). Clinically useful strength, defined as M3 or greater, was obtained in 100% of graft patients versus 87.2% of transfer patients (p=0.102). Grade M4 or better strength was obtained in approximately 84.2% of graft patients and 72.5% of transfer patients (p=0.392).
Conclusions: Significant clinical differences in functional outcomes between nerve graft and transfer procedures for isolated, post-traumatic axillary nerve injuries are not apparent at this time. Prospective outcomes studies are needed to better elucidate if functional differences do exist.
Methods: A systematic review was performed using the PubMED, SCOPUS, and Cochrane databases in order to identify all cases of isolated, post-traumatic axillary nerve injuries in patients 18 years or older. Patients who underwent axillary nerve reconstruction were included and categorized by technique: graft or transfer. Demographics were recorded, as well as concomitant injuries. Functional outcomes were compared, including British MRC strength and range of motion.
Results: Twelve retrospective studies met criteria, for a total of 66 patients (19 nerve grafts, 47 nerve transfers). Median time from injury to operation was equivalent across the nerve graft and nerve transfer groups (6.9 months versus 7.3 months; P=0.546). Postoperative follow-up was 12 months for patients who underwent nerve grafting versus 18 months those who had transfers (P=0.022). Clinically useful strength, defined as M3 or greater, was obtained in 100% of graft patients versus 87.2% of transfer patients (p=0.102). Grade M4 or better strength was obtained in approximately 84.2% of graft patients and 72.5% of transfer patients (p=0.392).
Conclusions: Significant clinical differences in functional outcomes between nerve graft and transfer procedures for isolated, post-traumatic axillary nerve injuries are not apparent at this time. Prospective outcomes studies are needed to better elucidate if functional differences do exist.