Can vascularization improve the surgical outcome of the intercostal nerve transfer for traumatic brachial plexus palsy? A clinical comparison of vascularized and non-vascularized methods.

It is very difficult to design a well-controlled comparative study for clarifying the value of vascularized nerve grafting in clinical cases. In order to understand whether or not the vascularizing procedure has any clinical value in nerve transfer and in nerve grafting, we compared non-vascularized with vascularized intercostal nerve transfer in patients with brachial plexus injury. Factors that were likely to affect the results were controlled. We found there was no significant difference in the functional outcome and no difference in the regenerating rate of the nerves between nonvascularized and vascularized intercostal nerve transfer. We concluded that the vascularizing procedure had little clinical value not only in intercostal nerve transfer, but also in nerve grafting irrespective of the length of the gap, when the recipient bed had normal vascularity.