Direct Nerve Sutures in (Extended) Upper Obstetric Brachial Plexus Repair.

J Bahm,S Bouslama,F Schuind,A Gkotsi,W El-Kazzi

doi:10.1055/s-0037-1608624

Abstract

Background In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks. Objectives We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8.4 months. Methods Analysis of functional results after a minimum of 18 months was conducted using the British Medical Research Council (BMRC) scale. Results All children reached 60–90° of elbow flexion and 75° of shoulder abduction at already six months after surgery. For those patients having already passed one year post surgery, the mean active shoulder abduction reached 92°, and for those who past the 18 months 124°. We discuss the actual knowledge about nerve coaptation under “reasonable” tension including its advantages and drawbacks. Conclusion This technique may be indicated in preoperatively selected cases of (extended) upper OBPP and may give good functional results.

Highlights

Severe upper and total obstetric brachial plexus palsies (OBPPs) need early surgical exploration and microsurgical reconstruction.[1]
In rare, selected cases of severe upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks
We discuss the actual knowledge about nerve coaptation under “reasonable” tension including its advantages and drawbacks. This technique may be indicated in preoperatively selected cases of upper OBPP and may give good functional results

Summary

Introduction

Severe upper and total obstetric brachial plexus palsies (OBPPs) need early surgical exploration and microsurgical reconstruction.[1] The brachial plexus lesion is routinely exposed through a transverse supraclavicular approach and consists most often in root ruptures and/or avulsion(s) associated with neuroma formation in the supra- and retroclavicular space. Root avulsions may not be addressed surgically and repaired directly in young children, if two or three root stumps remain, an intraplexic reconstruction after resection of the neuroma with autologous bridging grafts is most often feasible. In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks

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Methods

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Discussion

Conclusion