Final Results of Grafting versus Neurolysis in Obstetrical Brachial Plexus Palsy

Lin, Jenny C.; Schwentker-Colizza, Ann; Curtis, Christine; Clarke, Howard M.

doi:10.1097/prs.0b013e318199f4eb

Cited by 84 publications

(66 citation statements)

References 20 publications

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“…35,46 Even functional hand reinnervation can be obtained in patients with NBPP and is actually the first objective of reconstruction in those with complete palsy. The 2 main explanations for this success are that 1) the potential for axon growth is greater in young children, and 2) the distances from the repaired brachial plexus to the muscle targets are shorter.…”

Section: Neonatal Brachial Plexus Palsymentioning

confidence: 99%

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Socolovsky

Malessy

Lopez

et al. 2017

FOC

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OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.

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Section: Neonatal Brachial Plexus Palsymentioning

confidence: 99%

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Socolovsky

Malessy

Lopez

et al. 2017

FOC

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“…This procedure has been shown to generally provide good functional results. 9 However, it does involve complete transection of the nerves, sacrificing any potentially functional axons that remain. In addition, it would require harvesting at least one, but likely both, sural nerves.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography for neonatal brachial plexus palsy

Joseph¹,

DiPietro

Somashekar

et al. 2014

PED

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Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asymmetrical and atrophied on the affected side. Importantly, ultrasound examination of the shoulder revealed posterior glenohumeral laxity. Instead of pursuing the primary nerve reconstruction first, timely treatment of the shoulder subluxation prevented formation of joint dysplasia and formation of a false glenoid, which is a common sequela of this condition. Because the muscles innervated by proximal branches of the cervical nerve roots/trunks were radiographically normal, subsequent nerve transfers were performed and good functional results were achieved. The authors believe this to be the first report describing the utility of ultrasonography in the surgical treatment planning in a case of NBPP. Noninvasive imaging, in addition to thorough history and physical examination, reduces the intraoperative time required to determine the extent and severity of nerve injury by allowing improved preoperative planning of the surgical strategy. Inclusion of ultrasonography as a preoperative modality may yield improved outcomes for children with NBPP.

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“…External neurolysis consists in removing scaring around the nerve. It has not been proved to be an effective isolated procedure 42 , but it is a necessary step for other reconstructive strategies.…”

Section: Surgerymentioning

confidence: 99%

“…Combined infraclavicular approach through a deltopeitoral incision is rarely necessary in cases of lower trunk lesions, but section of the clavicle is usually not performed. Intraoperative nerve stimulation is crucial for the identification of viable neural structures, but recording of nerve action potentials across the sites of lesions has not been proved to be advantageous in this particular situation 12,40,42 . The typical lesion found is the neuroma in continuity (Figure 3), in which there is an internal rupture of axons and disorganization of the supporting connective tissue, corresponding to lesions type 3 or 4 in the Sunderland classification 43 .…”

Section: Surgerymentioning

confidence: 99%

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Neonatal brachial plexus palsy: a permanent challenge

Heise

Martins

Siqueira

2015

Arq. Neuro-Psiquiatr.

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Neonatal brachial plexus palsy (NBPP) has an incidence of 1.5 cases per 1000 live births and it has not declined despite recent advances in obstetrics. Most patients will recover spontaneously, but some will remain severely handicapped. Rehabilitation is important in most cases and brachial plexus surgery can improve the functional outcome of selected patients. This review highlights the current management of infants with NBPP, including conservative and operative approaches.

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Final Results of Grafting versus Neurolysis in Obstetrical Brachial Plexus Palsy

Cited by 84 publications

References 20 publications

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Ultrasonography for neonatal brachial plexus palsy

Neonatal brachial plexus palsy: a permanent challenge

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