Oberlin and Mackinnon Procedures for Partial Postganglionic Brachial Plexus Injury: A Case Report

Introduction: Brachial plexus injuries (BPIs) can result in significant motor and sensory dysfunction, profoundly impacting patients' quality of life. The Oberlin and Mackinnon procedures have emerged as promising surgical interventions for partial postganglionic BPIs, offering functional recovery and improved patient outcomes. Case Presentation: A 32-year-old male presented with a six-month history of progressive weakness and paresthesia in his right upper limb following a motorcycle accident. Electromyography and magnetic resonance imaging confirmed a diagnosis of partial postganglionic BPI involving C5-8 nerve roots, with preservation of the T1 root. The patient underwent the Oberlin and Mackinnon procedures under general anesthesia. Intraoperative neurophysiological monitoring was utilized to guide the selection of functional fascicles for transfer. The Oberlin procedure involved the transfer of a fascicle from the ulnar nerve to the biceps branch of the musculocutaneous nerve, while the Mackinnon procedure consisted of a double fascicular transfer from the median nerve to the anterior interosseous and radial nerves. Aggressive postoperative rehabilitation focused on strengthening exercises, range of motion activities, and sensory re-education. Discussion: At nine months post-surgery, the patient demonstrated marked improvement in elbow flexion (MRC grade 4), wrist extension (MRC grade 5), and hand grip strength (MRC grade 3) and sensation improvement across the affected limb. Early surgical intervention and careful preoperative evaluation were crucial factors contributing to the success of the Oberlin and Mackinnon procedures in this case. The aggressive rehabilitation regimen played a vital role in maximizing functional recovery and patient satisfaction. Conclusion: Oberlin and Mackinnon procedures gave significant functional recovery and patient satisfaction when combined with aggressive postoperative rehabilitation. Keywords: Brachial plexus injury, Oberlin procedure, Mackinnon procedure, nerve transfer.