Long-nerve grafts and nerve transfers demonstrate comparable outcomes for axillary nerve injuries

J Hand Surg Am. 2014 Jul;39(7):1351-7. doi: 10.1016/j.jhsa.2014.02.032. Epub 2014 Apr 29.


Purpose: To compare the functional and EMG outcomes of long-nerve grafts to nerve transfers for complete axillary nerve palsy.

Methods: Over a 10-year period at a single institution, 14 patients with axillary nerve palsy were treated with long-nerve grafts and 24 patients were treated with triceps-to-axillary nerve transfers by the same surgeon (S.W.W.). Data were collected prospectively at regular intervals, beginning before surgery and continuing up to 11 years after surgery. Prior to intervention, all patients demonstrated EMG evidence of complete denervation of the deltoid. Deltoid recovery (Medical Research Council [MRC] grade), shoulder abduction (°), improvement in shoulder abduction (°), and EMG evidence of deltoid reinnervation were compared between cohorts.

Results: There were no significant differences between the long-nerve graft cohort and the nerve transfer cohort with respect to postoperative range of motion, deltoid recovery, improvement in shoulder abduction, or EMG evidence of deltoid reinnervation.

Conclusions: These data demonstrate that outcomes of long-nerve grafts for axillary nerve palsy are comparable with those of modern nerve transfers and question a widely held belief that long-nerve grafts do poorly. When healthy donor roots or trunks are available, long-nerve grafts should not be overlooked as an effective intervention for the treatment of axillary nerve injuries in adults with brachial plexus injuries.

Type of study/level of evidence: Therapeutic III.

Keywords: Axillary nerve; brachial plexus; nerve graft; nerve transfer; outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Axilla / innervation*
  • Brachial Plexus / injuries*
  • Brachial Plexus / surgery*
  • Brachial Plexus Neuropathies / diagnosis
  • Brachial Plexus Neuropathies / physiopathology
  • Brachial Plexus Neuropathies / surgery*
  • Cohort Studies
  • Electromyography*
  • Female
  • Follow-Up Studies
  • Graft Survival
  • Humans
  • Male
  • Middle Aged
  • Nerve Regeneration / physiology
  • Nerve Transfer / methods*
  • Neurosurgical Procedures / methods
  • Peripheral Nerve Injuries / diagnosis
  • Peripheral Nerve Injuries / physiopathology
  • Peripheral Nerve Injuries / surgery*
  • Postoperative Care / methods
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Time Factors
  • Tissue Transplantation / adverse effects
  • Tissue Transplantation / methods
  • Treatment Outcome