Microsurgery for Obstetrical Brachial Plexus Palsy

Swan, Marc C.; Clarke, Howard M.

doi:10.1007/978-1-4614-8515-5_28

Cited by 4 publications

(4 citation statements)

References 77 publications

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“…Neuroma excision and interpositional nerve grafting remains the standard for primary brachial plexus reconstruction of postganglionic (extraforaminal) nerve root ruptures and is reviewed in greater detail elsewhere. 40 [See Video 3 (online), which displays the use of fibrin glue without microsutures for interposition of nerve autografts in brachial plexus reconstruction. Our institution’s preference for the use of fibrin glue rather than microsutures is attributed to several advantages, including being more user-friendly, less technically difficult, and more time efficient.…”

Section: Neuroma Excision and Interpositional Nerve Graftingmentioning

confidence: 99%

Recent Advances in the Treatment of Brachial Plexus Birth Injury

Zuo

Hopyan

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Learning Objectives: After studying this article, the participant should be able to: 1. Describe methods of clinical evaluation for neurologic recovery in brachial plexus birth injury. 2. Understand the role of different diagnostic imaging modalities to evaluate the upper limb. 3. List nonsurgical strategies and surgical procedures to manage shoulder abnormality. 4. Explain the advantages and disadvantages of microsurgical nerve reconstruction and distal nerve transfers in brachial plexus birth injury. 5. Recognize the prevalence of pain in this population and the need for greater sensory outcomes evaluation. Summary: Brachial plexus birth injury (BPBI) results from closed traction injury to the brachial plexus in the neck during an infant’s vertex passage through the birth canal. Although spontaneous upper limb recovery occurs in most instances of BPBI, some infants do not demonstrate adequate motor recovery within an acceptable timeline and require surgical intervention to restore upper limb function. This article reviews major advances in the management of BPBI in the past decade that include improved understanding of shoulder pathology and its impact on observed motor recovery, novel surgical techniques, new insights in sensory function and pain, and global efforts to develop standardized outcomes assessment scales.

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Section: Neuroma Excision and Interpositional Nerve Graftingmentioning

confidence: 99%

Recent Advances in the Treatment of Brachial Plexus Birth Injury

Zuo

Hopyan

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…Prepare for neuroma excision and stump sampling for frozen section Calculate amount of sural nerve graft required to reconstruct resultant defect and consider options for intraplexal or extraplexal neurotization Cut grafts to length for proposed plexus reconstruction in a tension-free manner; prepare fibrin sealant Ensure meticulous hemostasis within the wound bed; no further irrigation during gluing of grafts Glue grafts in situ using a fibrin sealant; ensure optimal orientation using an operating microscope Wound closure to include redraping of Brown's fat pad, repair of omohyoid muscle, and reattachment of sternocleidomastoid muscle No surgical drain required Skin closure in layers using absorbable sutures; infiltrate local anesthesia Simple wound dressing; application of Velpeau sling, or external rotation splint/cast Source: Reproduced with permission from Swan and Clarke. 20 pathological findings, note of particularly challenging specimens to obtain, any relevant intraoperative findings). Once all slides have been reviewed and the findings discussed, the surgical team returns to the operating room.…”

Section: Perform Intraoperative Nerve Stimulation To Help Differentia...mentioning

confidence: 99%

“…A detailed description of our technical approach to microsurgical reconstruction of the brachial plexus has previously been published 3 19 20 ( Table 3 ). One can refer to these reports for details regarding sural nerve harvesting and brachial plexus exposure/dissection.…”

Section: Operative Protocolmentioning

confidence: 99%

Management of Brachial Plexus Birth Injury: The SickKids Experience

et al. 2023

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This article describes the approach utilized by the multidisciplinary team at Sick Kids Hospital to evaluate and treat patients with brachial plexus birth injury (BPBI). This approach has been informed by more than 30 years of experience treating over 1,800 patients with BPBI and continues to evolve over time. The objective of this article is to provide readers with a practical overview of the Sick Kids approach to the management of infants with BPBI.

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“…It is agreed that in those children who meet the criteria for surgical intervention, treatment should not be delayed, as this is likely to prejudice the maximal benefit that could otherwise be obtained [5].…”

Section: Introductionmentioning

confidence: 99%