Apoptosis of proximal stump postganglionic brachial plexus injury, before and after six months post-trauma

Abstract

Background The success of the micro-surgery procedure for the treatment of postganglionic brachial plexus injury was influenced by several factors, including the surgical timing and also the viability of the proximal stump. This study evaluates the evidence of apoptosis in the brachial plexus proximal stump and its correlation with the surgical timing. Methods Proximal stump biopsy of postganglionic brachial plexus injury patients were obtained during nerve procedure surgery. The samples were grouped based on the surgical timing, before six months post-trauma (early group) and after six months post-trauma (late group). The apoptosis of motorneurons was evaluated by immunohistochemistry expression of Caspase-3, TNF-α, Caspase-8, and Caspase-9. Results Immunohistochemistry findings showed higher expression of Caspase-3 in the late group compared to the early group, as well as the expression of Caspase-8 and Caspase-9 (p < 0,05), and with a positive correlation between Caspase-8 and Caspase-9 to Caspase-3. Meanwhile, TNF-α expression was higher in the early group than the late group (p < 0,05) and with no correlation between TNF-α to Caspase-3. Conclusion Apoptosis of proximal stump motorneuron plexus brachialis on more than six months post-trauma is higher than on less than six months post-trauma.

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country

“…The expression of pro-apoptotic markers (Caspase-3, Caspase-8, and Caspase-9) in the proximal stump biopsy of BPI patients who were operated on in late presentation (more than six months following trauma) was significantly higher than those who were operated on in early presentation (less than six months), suggesting the importance of performing nerve procedure surgery as soon as possible for a more desirable result. 35 The average time to surgery in our study was 16.8 months, with the majority of the patients (76.6%) had delayed or late surgery (more than six months). This may partly explain the insignificant outcomes found in our cohorts.…”

Early external neurolysis surgery reduces the pain and improves the functional outcomes and quality of life among traumatic brachial plexus injury patients

“…7,9, 15 One of the essential factors determining the nerve procedure's success is the The numbers of apoptosis of nerve's proximal stump on more than six months post-trauma is higher than on less than six months post-trauma. 22,23 This occurs because the expression of tumor necrosis factor-alpha (TNF-α) and Caspase on patients who underwent surgery after six months was higher than before six months. 23 This was the supported by the previous studies.…”

“…22,23 This occurs because the expression of tumor necrosis factor-alpha (TNF-α) and Caspase on patients who underwent surgery after six months was higher than before six months. 23 This was the supported by the previous studies. Studies concluded that the optimal time to surgery on TBPI patients are between 3-6 month.…”

Clinical and functional outcome after different surgical approaches for brachial plexus injuries: Cohort study

“…Agreements in BPI management, such as surgical options (nerve transfer, nerve grafting, neurolysis, and functional muscle transfer) should be generally performed within six months of injury [ 24 ]. In postganglionic BPI, nerve surgery procedure may be performed as early as possible to obtain optimal outcomes [ 25 ]. Surgery indicated in severe BPI is generally performed three to four months after the injury.…”