Brachial plexus palsies are often devastating injuries leading to severe functional impairment of the upper limb. Their surgical management has greatly changed in the last 30 years and it is still evolving but nowadays the key role of surgery in reversing the destiny of many of these patients is clearly recognized.The Authors are presenting their guidelines of management and repair strategy in the surgical treatment of these injuries. In upper brachial plexus injuries, surgery restored good shoulder and elbow function in more than 90% of cases, regardless the presence of avulsions. Total palsies still retaining some hand function (due to one lower root in continuity with the spine) also received remarkable benefit in about 60% of cases. Shoulder and elbow function were recovered in 40% of complete injuries with multiple avulsions. Although the first description of a brachial plexus (BP) palsy was given by Homer in the duel between Hector and Teucrus in the 8th book of the Iliad, these injuries were recognized as a separate clinical entity among peripheral nerve lesions only in the first half of the 19th century and their surgical repair was first attempted towards the end of the century. During the first decades of the 20th century, the knowledge of these lesions progressed. Surgery is performed in the supine position under general anesthesia, no muscular blocks are used. It usually includes two stages: exploration of the brachial plexus and its microreconstruction via an anterior approach. Exploration is not performed in lower plexus injuries, root avulsions having always been clearly revealed at MRI.
Debora Garozzo, Brachial Plexus Injuries in Adults: Management and Repair Strategies in
our Experience. Results from the Analysis of 428 Supraclavicular Palsies
Last date updated on June, 2014