Outcomes of Brachial Plexus Reconstruction in 204 Patients with Devastating Paralysis

Abstract

Thus far, devastating injuries of the adult brachial plexus have had a poor prognosis. This article presents the possible outcomes of aggressive microsurgical reconstruction in the largest series of patients in North America to date. It should change the pessimistic outlook that has surrounded these lesions. In this study, the outcomes of surgery were analyzed in relation to the type and level of injury, the age of the patient, and the denervation time; stronger donors for neurotization in relation to the various targets were delineated. The results were analyzed in 204 patients with adequate follow-up from a total of 263 patients who were operated on between 1978 and 1996. The mean age of the patients was 25.9 years, and the injuries were caused by high-velocity motor accidents involving avulsion in 55 percent of the patients. Nerve reconstruction included 577 nerve repairs (140 direct neurotizations and 437 cases of nerve grafting). Microneurolysis was performed in 89 cases. Vascularized nerve grafts were used in 120 repairs. Muscle transfers (29 pedicled and 78 free) were used to enhance function. The results were good or excellent in 75 percent of suprascapular nerve reconstructions, 40 percent of deltoid reconstructions, 48 percent of biceps reconstructions, 30 percent of triceps reconstructions, 35 percent of finger-flexion reconstructions, and 15 percent of finger-extension reconstructions. The majority of the patients had protective sensation and pain relief postoperatively.

Sialidase enhances spinal axon outgrowth in vivo

“…Often associated with young adults in motor vehicle accidents, recovery is typically poor, resulting in lifelong disability from loss of significant motor and sensory function of the affected limb (8). Upon nerve root avulsion, the microscopic environment of the severed axons within the CNS is highly inhibitory, as evidenced by characteristic terminal retraction balls on axon pathways between the ventral horn and the pia mater (9).…”

Free Muscle Transfer in Posttraumatic Plexopathies Part II: The Elbow

“…For this reason, during the primary reconstruction, the best motor donor is used to neurotize the musculocutaneous nerve. For secondary elbow reconstruction, techniques such as the pedicled muscles transfers [21,39] …”

Evaluation of suprascapular nerve neurotization after nerve grafting or transfer in the treatment of brachial plexus traction lesions

“…33 This may explain the superior results in combined series. 35 Third, we did not routinely dissect the suprascapular nerve up to the level of the scapular notch. Therefore, we may have missed two-level lesions of the suprascapular nerve.…”

“…14,24 In adults who have undergone brachial plexus reconstruction, good results of shoulder function recovery have been reported. 1,4,7,10,21,22,24,28,34,35 Interpretation of the data presented, however, is difficult for the following reasons. First, the outcome data pertaining to different types and localizations of lesions have been pooled-for instance, superior trunk lesions have been grouped with axillary nerve lesions, and traction lesions with gunshot wounds and sharp wounds.…”