[Upper brachial plexus palsy. Seven cases treated by muscle transplantation (author's transl)].

Abstract

Seven cases of upper brachial plexus palsy, have been treated by associated transplantation of pectoralis major for flexion, and of teres major and latissimus dorsi for external rotation. Operation was performed eighteen months at least after injury, during which period rehabilitation was necessary to prevent atrophy of the pectoralis major and contracture in internal rotation. The strength of flexion was improved by alterations of the original Clark's operation. The whole muscle was transplanted: its humeral tendon was fixed to the coracoid process; its thoracic extremity lengthened by an aponevrotic flap from rectus anterior was pulled through a posterior anti-brachial incision, holding the arm in anteposition and the forearm in supination. A strong tension was obtained in this way. Transplantation of teres major and latissimus dorsi tendons behind the humerus was done in the same stage. Results are in favor of these improvements: all seven patients, including two hard-workers, obtained a strong and large flexion. The useful part of external rotation was restored. All went back to their former occupations.