Brachial Plexus Injuries in Adults: Management and Repair Strategies in our Experience. Results from the Analysis of 428 Supraclavicular Palsies

Abstract

This report aims to present the guidelines of management and repair strategy in the surgical treatment of brachial plexus injuries (BPI) according to the Authors' experience, by analyzing a surgical series of 428 supraclavicular lesions. Methods From April 1990 to June 2013 the Authors have operated 578 posttraumatic BPI in adults: 428 supraclavicular and 150 infraclavicular injuries. Supraclavicular lesions have been retrospectively reviewed, focusing on the diagnostic assessment, the timing of surgery, the surgical findings, the repair strategies and their outcome. Infraclavicular injuries have been excluded from this study due to their higher variability in findings, with consequent lack of homogeneity in outcome. Preoperative assessment Patients were evaluated clinically (Figure 1) and by neuroradiological (MyeloCT or MR Myelography) (Figure 2) and electrodiagnostic studies (EDS). Imaging studies are preferably indicated after 3-4 weeks from the causative event due to the fact that pseudomeningoceles need a few weeks to form [1,2].

Use of the Facial Artery for Free Functioning Muscle Transfers: An Alternative Pedicle for Salvage in Brachial Plexus Lesions with Vascular Injuries

“…Nerve reconstruction in extensive brachial plexus injuries is a challenge as the roots are often completely avulsed. [1][2][3] In such instances, the spinal accessory, and phrenic and intercostals nerves are frequently utilized to restore important functions about the shoulder (rotator cuff) and the elbow (biceps). 4,5 The outcomes of such procedures depend on two main factors-the age of the patient and the delay since the accident.…”

Brachial Plexus Injuries in Adults: Guidelines and Management in our Experience

“…In 2006, a national prevalence of approximately 350.000 patients and an annual incidence of roughly 3500 new BPIs per year were estimated in the United States of America (USA). There are increasing incidences of these lesions (Narakas 1985;Ferraresi et al 1994;Jain et al 2012;Kaiser et al 2012;Garozzo et al 2013;Faglioni et al 2014;Park et al 2017), due to the spreading motorization in developing countries (especially in South-East Asia) and the ongoing warfare in the Arab world. The compulsory use of safety helmets has resulted in a higher survival rate after motorcycle accidents in comparison with the past.…”

“…Male patients aged between 15 and 35 years largely predominate (Narakas 1985;Ferraresi et al 1994;Midha 1997; Jain et al 2012;Kaiser et al 2012;Garozzo et al 2013;Faglioni et al 2014;Park et al 2017). A favourable evolution can occur in some cases with neurapraxic injuries, but root avulsions (Fig.…”

“…A favourable evolution can occur in some cases with neurapraxic injuries, but root avulsions (Fig. 1) are present in more than 70% of cases (Narakas 1985;Ferraresi et al 1994;Garozzo et al 2013;Garozzo 2017;Park et al 2017), thus ruling out any possibility for spontaneous recovery in the vast majority of these patients.…”

Nerve grafting vs. common infraclavicular intraplexal nerve transfer in elbow flexion restoration

“…The treatment options include neurolysis, direct nerve repair, nerve grafting, and nerve transfer (11,19,20). However, since the majority of these injuries are traction or avulsion injuries, nerve transfer is usually the only option for satisfactory recovery.…”