Long Head of the Triceps Branch Transfer to Axillary Nerve in C5, C6 Brachial Plexus Injuries: Anterior Approach

Shoulder abduction is a very complex movement and quite important for upper limb function, as more distal functions depend on a stable shoulder, especially in C5, C6 brachial plexus injuries. Various studies in the literature have emphasized the importance of improved functional outcome and shoulder reanimation with concomitant neurotization of suprascapular nerve and axillary nerve in C5, C6 brachial plexus injuries. A number of approaches to axillary nerve transfer in brachial plexus injuries have been reported. The author describes an innovative anterior deltopectoral approach for axillary nerve transfers in five patients with C5, C6 brachial plexus injuries. The spinal accessory nerve was neurotized with the suprascapular nerve through a transverse supraclavicular incision. The axillary nerve and the long head of the triceps branch were identified through the anterior deltopectoral approach and neurotized at the posterior cord level. This approach gives easy access to other donors such as the medial pectoral, thoracodorsal, and median and ulnar nerves. Oberlin's transfer was also performed for elbow flexion by extending the deltopectoral incision. The regained shoulder active abduction (M5) averaged 120 degrees and active external rotation averaged 65 degrees at the final follow-up of 26 months (average). This anterior deltopectoral approach is an excellent alternative for axillary nerve transfer in brachial plexus injuries and produces results comparable with those of other approaches. All brachial plexus surgeons must understand the anatomy and the relationship of the axillary nerve to the surrounding structures. (Plast. Reconstr. Surg. 128: 740, 2011.)