nerve_grafting [Neurosurgery Wiki]

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[[Brachial plexus palsy]] is a surgically manageable condition. Re-animating the [[shoulder]] is a high priority for restoring upper extremity function. Methods for reinnervating injured nerves include the transfer of a healthy [[nerve]] or fascicle distal to the site of injury, or [[grafting]] a healthy sensory nerve to restore motor function. Studies aiming to compare these two techniques for restoring [[shoulder abduction]] have yielded conflicting results. 

Hardcastle et al., conducted a systematic review and meta-analysis following the [[PRISMA guideline]]s. They reviewed the PubMed database for studies comparing [[nerve transfer]] and nerve grafting for [[shoulder abduction]] published by December 2018. Outcomes using the Medical Research Scale (MRC) for muscle strength were assessed using a random effects model meta-analysis. Five studies comprising a total of 212 patients (n = 158, nerve transfer; n = 54, nerve grafts) were used for the analysis. The rate of functional recovery of shoulder function was slightly better for nerve transfer (n = 114/158, 72%) than for nerve graft patients (n = 36/54, 67%). However, this was not statistically significant (OR 1.34, 95% CI 0.27-6.72, I2 = 62.9%). [[Nerve transfer]] and [[grafting]] are similarly effective in terms of [[shoulder abduction]]. Future prospective studies are needed to validate the [[result]]s and identify the optimal shoulder re-animation strategy in patients with brachial plexus injuries
((Hardcastle N, Texakalidis P, Nagarajan P, Tora MS, Boulis NM. Recovery of
shoulder abduction in traumatic brachial plexus palsy: a systematic review and
meta-analysis of nerve transfer versus nerve graft. Neurosurg Rev. 2019 Apr 17.
doi: 10.1007/s10143-019-01100-9. [Epub ahead of print] Review. PubMed PMID:
30997618.
)).