All the articles evaluated selleck chem Axitinib have the use of the ulnar nerve as a donor for reinnervation of the biceps brachii as a technical principle. There was considerable variation in the methodology of the studies and in the presentation of results. Article IX 12 presented nine cases; however, three of these were disregarded as they involved the use of ulnar nerve fascicles for neurotization of the free gracilis muscle. Of the 43 cases in article VII, 10 four used the median nerve as a donor, and were also excluded from the study. According to the clearness and objectivity of the data provided, these were either put to use or discarded. The compilation of the data obtained leads to the following results: – 182 patients were assessed. – One hundred forty-three had their sex specified by the authors, of these 92% were men.

– The estimated average age was 26 years, ranging between 15 and 66 years. – The etiology of the injuries receives little attention in these reports; but when mentioned, motorcycle accidents are highlighted. – Associated traumatisms are neither specified nor valued. – One hundred twenty-five patients presented deficit of C5-C6 and 57, deficit of C5-C6-C7. – The function of the extrinsic flexors in the preoperative period was evaluated in Articles IV, V, VI, VII and VIII. – The estimated mean time interval between accident and surgery was 7.3 months. – Sixty-six patients were submitted to concomitant procedures: intraplexual and extraplexual neurotizations (accessory nerve to suprascapular nerve, triceps motor branch to axillary nerve) – The postoperative follow-up period ranged from 6 to 84 months, averaging 20 months.

– Clinical signs of reinnervation (MRC grade M1 contraction) appeared between two and six months. – The end result obtained for elbow flexion strength was MRC grade > M3 in 85.2 % and grade > M4 in 75.3 % of the patients. – There is a consensus regarding low morbidity for the ulnar nerve with gradual improvement of hand sensitivity and increase in grip strength in the postoperative period in all the articles. The results obtained in elbow flexion strength, graded by the MRC, are correlated to the variables: injury level, interval between trauma and surgery and age bracket; and are represented in the graphs from Figures 8, ,99 and and1010 respectively. Figure 8 Relation between the injury level and the MRC grade of strength of the biceps brachii.

Considering 182 cases from the literature. Figure 9 Relation of the time interval between the BP trauma and surgical treatment with the MRC grade of strength of the biceps brachii. Considering 95 cases (Articles I [partial], II, III, IV, VIII and IX) from the literature. Figure Carfilzomib 10 Relation between age bracket and the MRC grade of strength of the biceps brachii. Considering 97 cases ( Articles I, II, III, IV, VIII and IX) from the literature. DISCUSSION As advocated by Hentz and Doi, 2 reestablishing active elbow flexion in brachial plexus injuries is a priority.