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. 2025 Aug 6;13(8):e6969.
doi: 10.1097/GOX.0000000000006969. eCollection 2025 Aug.

Patient-reported Outcomes Following Intercostal Nerve Transfer to Musculocutaneous Nerve at a Median Follow-up of 3.5 Years

Noémie Allio  1 , Thibault Druel  1 , Victor Rutka  1 , Camille Brenac  2 , Laurent Mathieu  1   3 , Aram Gazarian  1   4 , Arnaud Walch  1
Affiliations

Patient-reported Outcomes Following Intercostal Nerve Transfer to Musculocutaneous Nerve at a Median Follow-up of 3.5 Years

Noémie Allio et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: The objective of this study was to evaluate the outcomes of neurotization of the musculocutaneous nerve (MCN) using intercostal nerves (ICNs) to restore elbow flexion in patients with complete brachial plexus paralysis (CBPP). We assessed quality of life through patient-reported outcome measures and examined the impact on respiratory function.

Methods: This retrospective study included 17 patients with CBPP who underwent ICN transfer to the MCN. The median follow-up was 3.5 years. Outcome measures included elbow flexion strength (British Medical Research Council grading), quality of life (Quick Disabilities of the Arm, Shoulder, and Hand and Short Form-36), and respiratory function. Patient-reported outcome measures were evaluated using the Overall Subjective Self-Assessment score.

Results: The median age at the time of injury was 24 years (interquartile range: 19-28 y). Seven (41%) patients achieved elbow flexion strength of M3 or higher. The median active elbow flexion was 120 degrees in patients with strength of M3 or higher, compared with 25 degrees in those with strength less than M3 (P < 0.001). The median Quick Disabilities of the Arm, Shoulder, and Hand score was 68 for patients with strength of M3 or higher and 84 for those with strength less than M3 (P = 0.04). The Short Form-36 score showed a median of 58 for patients with strength of M3 or higher and 47.5 for those with strength less than M3 (P = 0.14). No significant changes in respiratory function were observed.

Conclusions: Neurotization of the MCN with ICN in patients with CBPP can restore functional elbow flexion and improve quality of life without adversely affecting respiratory function. Although improvements remain modest, the restored elbow flexion significantly enhances upper limb function, supporting its continued use as a viable treatment option in the management of CBPP.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Axillary union of ICNs (original).
Fig. 2.
Fig. 2.
Epiperineural microsuture.
Fig. 3.
Fig. 3.
Flexion strength measured with scale.
See this image and copyright information in PMC

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