Delayed Procedures in Irreparable Brachial Plexus Injuries

Abstract

Background: The management of brachial plexus injury represents one of the most complex challenges. Surgical options include neurolysis, neurorrhaphy, repair with nerve graft, and neurotization. Delayed procedure are required to restore and salvage function in patients with late presentations and in a setting of suboptimal results of primary procedures. Appropriate timing is an important factor to be ascertained.

 Aims and objectives: The objectives are to establish the time of intervention, to evaluate the practical aspects of planning, operative technique, assessment of outcome in various muscle and tendon transfer procedures, as well as post-operative management and complications. Whenever feasible, the results of different procedures aimed at producing similar movements are also compared.

 Materials and Methods: A total of 19 patients underwent 20 delayed procedures between November 2010 and October 2013. All 19 patients included in the study were males. Selection criteria included patients who presented late (>9 months), and cases without spontaneous recovery or ones that showed no improvement after primary surgery.

 Observations and Results: Among the procedures, muscle transfers included free functional gracilis in 9, modified trapezius in 7 patients and latissimus dorsi transfer in 1 case, 2 Oberlin procedures and 1 tendon transfer were performed. The follow up period ranged between 12- 30 months, with majority of the patients showing M3 improvement.

Conclusion: Delayed procedures are an integral part of brachial plexus reconstruction since only partial recovery can be achieved in a subset of patients, especially with severe lesions. Timely intervention, surgical expertise and dedicated physiotherapy are the keystones for optimal improvement and recovery