Abstract Introduction Restoring elbow flexion is a primary goal in brachial plexus injury (BPI) reconstruction, as it is crucial for daily function. Ulnar nerve fascicle transfer and intercostal nerve (ICN) transfer are common surgical options. However, there is limited comparative data on their effectiveness, particularly within the Indonesian population. This study aimed to compare the clinical outcomes of these two procedures. Methods A retrospective comparative study was conducted on 24 adult BPI patients at RSUP H. Adam Malik. Patients were divided into two indication-based groups: ulnar nerve fascicle transfer for upper-type/upper-extended-type BPI ( n = 12) and intercostal nerve (ICN) transfer for total-type BPI ( n = 12). Clinical outcomes were assessed at the latest documented postoperative follow-up (minimum 2 months) using the Medical Research Council (MRC) scale for biceps muscle strength and goniometric measurement for active elbow flexion range of motion (ROM). Between-group comparisons were performed using the Mann-Whitney U test. Results The ulnar nerve transfer group achieved significantly better outcomes. The mean MRC score for the ulnar group was 2.45 (± 1.97), compared to 0.54 (± 0.25) for the ICN group ( p = 0.021). The mean active elbow flexion ROM was 72.73° (± 59.18°) in the ulnar group, versus 22.31° (± 12.76°) in the ICN group ( p = 0.041). Discussion The superior results of the ulnar nerve fascicle transfer are likely attributable to a shorter axonal regeneration distance and better physiological synergy between the donor (ulnar nerve) and recipient (musculocutaneous nerve) functions. Conclusion Ulnar nerve fascicle transfer provides significantly better clinical outcomes in restoring elbow flexion, in terms of both muscle strength and range of motion, compared to ICN transfer for BPI patients in this cohort.
Siregar et al. (Thu,) studied this question.
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