Brachial Plexus Surgery: Clinical Analysis of Ten Cases

Abstract

Background and Aim: Brachial plexus surgery is a complex surgery and multiple surgical techniques were advanced. The concept that patients who underwent surgery will obtain full recovery is still far from the truth. In this study, we show our results after usage some surgical techniques, aiming to describe them. Methods: Through case series study, the team operated 10 cases, including infants and adults (Seven males and three females) between January 2013 and June 2015. Detailed history, physical examinations, radiological imaging studies and electrophysiological studies were performed to confirm the nature and severity of the injury. Exclusion criteria, including individuals who spontaneously recovered after 4 months or those came after more than 12 months of injury. Neurolysis, nerve grafting and nerve transfer were done according to certain protocol performed for each case. Results:History of road traffic accident was reported in five cases, obstetric brachial plexus palsy in three cases, gunshot wound in two cases. They were diagnosed as upper brachial plexus injury (4 cases), lower brachial plexus injury (2 cases), and complete flail limb (4 cases). Four cases were submitted into neurolysis, three into nerve grafting, and three into the nerve transfer.Four cases showing functional motor outcome improvement (2 cases, Neurolysis and 2 cases, nerve transfer) but the other six cases do not show any improvement until now (3 nerve grafting, 2 neurolysis and 1 nerve transfer).Assessment of the motor power was done using the Medical Research Council scale. One case was complicated immediately post-operatively with pan plexopathy of the same limb of surgery and was improved one week after. Conclusion: Brachial plexus surgery renders satisfactory results for restoring the upper limb functions. The results shown that neurolysis and nerve transfer give better results than nerve grafting.