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Factors Affecting Outcome of Triceps Motor Nerve Transfer for Isolated Axillary Nerve Injury
Joo-Yup Lee, MD, PhD1; Michelle, F. Kircher, RN2; Robert J. Spinner, MD3; Allen T. Bishop, MD4; Alexander Y. Shin, MD4
1Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, South Korea; 2Neurological Surgery, Mayo Clinic, Rochester, MN; 3Department of Neurosurgery, Mayo Clinic, Rochester, MN; 4Department of Orthopedic Surgury, Mayo Clinic, Rochester, MN

Introduction: Since its introduction for upper brachial plexus injury, triceps motor nerve transfer (Leechavengvongs procedure) has been used for isolated axillary nerve injury in replacement of nerve grafting. We hypothesized that the outcome of this procedure is affected by many independent factors.

Methods: A retrospective chart review was performed of twenty-one patients (mean age, 38; range, 16-79 years) who underwent triceps motor nerve transfer for treatment of isolated axillary nerve injury. Deltoid muscle strength was evaluated using Medical Research Council (MRC) grading at the last follow-up (mean, 21; range, 12-41 months). We analyzed the following variables to determine whether they affected deltoid muscle strength: the age and sex of the patient, delay from injury to surgery, body mass index (BMI), the presence of rotator cuff lesions. Spearman’s correlation coefficient (ρ: rho) was used for correlation analysis, and multiple linear regression analysis was performed with correlated factors.

Results: The average MRC score of deltoid muscle strength was 3.55±1.1, and no patient had grade 5 results. Deltoid muscle strength correlated with the age of the patient (ρ=-0.544, p=0.011), delay from injury to surgery (ρ=-0.480, p=0.028), and BMI of the patient (ρ=-0.459, p=0.036). Five patients (24%) failed to achieve more than M3 grade. Among them, four patients were more than 50 years old and one was treated at 14 months after injury. In multiple linear regression model, the delay from injury to surgery, the age of the patient, and BMI of the patient were important factors in order that affects the outcome of this procedure.

Conclusion: Isolated axillary nerve injury can be treated successfully with triceps motor nerve transfer. However, outstanding outcomes are not universal with 24% failing to achieve M3 strength. Outcome of this procedure is affected by the age, BMI of the patient and the delay from injury to surgery.

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