Brachial Plexus Injury Repair: Optimizing Surgical Management in Low- to Middle-Income Countries

Abstract

Introduction Repair of brachial plexus injury (BPI) remains a neglected art in low- to middle-income countries (LMICs) where the more pertinent public health issues get priority and the facilities to manage such conditions are limited. We share our experience and provide recommendations to assist the existing and new facilities in providing the best care and spreading awareness.

Methods Over the period of 15 years, we have been managing patients with BPIs across age groups. Patients who could be followed for at least 1 year were included in the study. Etiological factors, neurological findings, procedure performed, and the outcome variables like improvement in power in the modified rankin scale (MRS) scale, sensory improvement, and functional capacity were studied.

 Results A cohort of 172 patients with BPIs (87.8% male, mean age 27.9 years) was analyzed. The most common etiology was road traffic accidents, predominantly involving motorbikes (81%). Surgical delay decreased from 67.5% to 10% by 2024, with a mean delay of 4 months. Surgical intervention outcomes were significantly influenced by early repair, with direct neurorrhaphy for peripheral nerve injuries achieving the best results (93.8%). Neurotization yielded a 79.6% good recovery rate in incomplete BPI. DREZotomy [Dorsal Root Entry Zone lesioning (or destruction/ section)] was performed in five patients with persistent pain, resulting in pain relief for all but one. No fatalities occurred, though four superficial infections were reported.

 Conclusion BPI repair procedures provide gratifying results. Challenges in LMICs are unique but can be addressed with persistent, comprehensive efforts with collaborations across various platforms and organizations.