Sensory Recovery of the Hand with Intercostal Nerve Transfer following Complete Avulsion of the Brachial Plexus

Background: Restoration of sensory function is imperative when prehensile function is restored after irreparable brachial plexus injury. However, there are few reports that focus on the results of sensory recovery after brachial plexus reconstruction. The purpose of this article is to report the results of sensory recovery of the hand with intercostal nerve transfer following complete brachial plexus injury. Methods: Seventeen patients with complete brachial plexus injury underwent sensory reconstruction of the hand with intercostal nerve transfer to the median or ulnar nerve. All patients underwent double free-muscle transfer to restore the prehensile function of the hand. Sensory recovery of the hand was assessed with Semmes-Weinstein monofilament testing, two-point discrimination, vibration perception, temperature perception, and the location of perception of sensibility. The average follow-up period was 4.1 years. Results: All patients perceived at least the 6.65 filament at the territory of the median or ulnar nerve. Best result on Semmes-Weinstein monofilament test was perception of the 4.31 filament in two patients. None of the patients had two-point discrimination. Vibration with 30-cycles/second stimuli was perceived in 12 patients, whereas vibration with 256-cycles/second stimuli was perceived in only six patients. Eight patients had perception of warmth, and 13 patients had perception of cold. Seven patients felt sensation in the cutaneous distribution of the repaired nerve of the hand in situ. Conclusions: Sensory reconstruction with intercostal nerve transfer can provide limited sensibility of the hand. However, this limited sensory recovery is useful for activities of daily living in severely handicapped patients with brachial plexus injury. (Plast. Reconstr. Surg. 123: 276, 2009.)