Purpose of the study: Recovery of active elbow flexion constitutes the first priority in microsurgical repair after closed injuries of the supraclavicular brachial plexus in adults. However, there are many controversial issues between the proponents of nerve grafting from available roots, and the proponents of nerve transfer.

Material and methods: The results concerning elbow flexor muscle recovery following microsurgical nerve repair of supraclavicular brachial plexus lesions were analysed in 62 patients. The average age at operation was 23 years old and the average delay between trauma and nerve repair was 7 months. Nerve grafting from C5 or C6 was performed in 43 patients. Nerve transfer using 3 intercostal nerves was done in 10 patients and using the spinal accessory nerve in 7 patients. A combination of both techniques was performed in 2 patients. Conventional sural nerve grafts were used every time. Functional evaluation was based on the assessment of active range of motion including flexion and supination, and on the assessment of maximum isotonic strength of the elbow flexors.

Results: With an average follow up of 8.5 years (range from 3 to 16 years) the average functional score of the elbow flexors was 4.4 out of a possible 11. Sixty six percent of patients had a strength recovery of M3 or more. Nerve repair using nerve graft from a non avulsed root seems to give better functional scores than nerve transfer from intercostal nerves or spinal accessory nerve using interpositional nerve graft, even if the differences were not statistically significant.

Discussion: In order to restore elbow flexion in case of supraclavicular brachial plexus lesion, nerve graft from an available root should be preferred to nerve transfer with interpositional nerve graft, when no avulsion exists among C5 and C6. Nerve transfer with interpositional nerve graft to the musculocutaneous nerve is indicated in case of avulsion of one or more roots among C5 and C6.