Tunneled Tensor Fascia Lata in Trapezius Transfer–A Novel Technique for Upper Brachial Plexus Injury

Abstract

Brachial plexus injuries are one of the most devastating injuries and also the most actively researched. The last four decades witnessed significant improvement in the management of these injuries, from a totally pessimistic outlook to a more optimistic attitude. The repair of such injuries is commonly done via multiple nerve transfer methods involving immense technical expertise. Trapezius muscle transfer is an established method to provide stability and function to the flail shoulder joint in brachial plexus injuries after denervation atrophy of the involved muscles. Problems associated with the current technique include longer surgery time, prolonged immobilization, screw loosening, surgical-site infection, and deformities after bony fracture. To overcome these problems, we described a technique using tensor fascia lata for extension of trapezius tendon, tunneled it under deltoid muscle, and sutured it to the deltoid tendon close to its insertion. As no implants were used, there were no implant-related complications. This technique can be adopted easily due to its shorter learning curve, with the only prerequisite being a passive shoulder abduction of at least 90 degrees. Trapezius transfer by this technique is a simple, easy, and convenient method, showing reliable result for shoulder abduction and flexion in cases of upper brachial plexus injury, which require secondary procedures, or those having delayed presentation of more than a year.