The restoration of the flexion of the elbow is the first goal in complete brachial plexus injuries. The current reconstructions, associating nerve grafts and nerve transfers, authorize more extensive repair, with different possible targets: shoulder, elbow extension, hand. We reviewed our series of intercostal nerve transfers onto the nerve to the long head of the triceps in order to evaluate the reliability of the technic and the functionnal results.

From 1998 to 2001, 26 patients presenting with a brachial plexus palsy sustained a direct nerve coaptation from intercostal nerves onto the nerve to the long head of the triceps. The mean age of the patients was 24.

There was 14 cases of complete medullar avulsions of all roots, 9 graftable C5roots. The last three cases concerned upper type plexus palsies, including a clinical palsy of the triceps. The mean preoperative delay was 4 months (1 to 14). Different other recontructions have been performed in the same time: cross C7 nerve transfer (17), ulnar-biceps transfer (3).

In all cases except one, 3 intercostal nerves were used. A subperiosteal approach permitted the harvesting of nerves in the 3rd to 5th intercostal spaces. The radial nerve was approached at the latissimus dorsi tendon level, where the branch to the long head of the triceps is easily identified. The repair consisted of a direct coaptation in all cases.

For 16 patients, the post operative delay is more than 12 months. Six patients obtained a grade 4 triceps, six a grade 3, one a grade 1. And there was three failures. Thus, the overall results were satisfactory in 75% of the cases, looking better that those of the recent literature. The satifaction degree of the patients is high. Because its reliability, this technic is possibly destinated to become a routine technic, may be allowing in the futur the reconstruction of the finger flexion by means of a tenodesis effect from the elbow motion.