Artikel
Traumatic lesions of the brachial plexus: an analysis of outcomes after primary brachial plexus reconstruction and secondary functional arm reanimation from a single service
Traumatische Plexus brachialis Läsionen: eine Analyse der Ergebnissen nach primären Plexus rekonstruktionen, sowie sekundäre Ersatzoperationen aus einer Klinik
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Autoren
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K.D. Martin
- Neurochirurgische Universitätsklinik, Universitätsklinikum Carl Gustav Carus, Dresden
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G. Schackert
- Neurochirurgische Universitätsklinik, Universitätsklinikum Carl Gustav Carus, Dresden
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K. G. Krishnan
- Neurochirurgische Universitätsklinik, Universitätsklinikum Carl Gustav Carus, Dresden
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: To retrospectively analyze the outcomes of primary, as well as secondary functional reconstructions in 58 patients with traumatic brachial plexus lesions (BP) treated at Carl Gustav Carus Universitätskrankenhaus Dresden between 2000 and 2006. The aim is to provide an account of the fate of patients with BP lesions after several treatment modalities. Guidelines for treatment might be extracted from this analysis.
Methods: Among 152 cases with traumatic lesions of the brachial plexus presented in our clinic, 58 (50 adults and 8 infants) underwent primary brachial plexus reconstructive surgery. On exploration, all patients showed stretching and scarring of plexus elements; of these 28 adults (56%) and one newborn (12.5%) showed root avulsions. An outcome evaluation was carried out in 49 of these patients with a follow-up of one year or more (mean follow-up: 27.9 months; range 12-72 months). A total number of 43 secondary reconstructive procedures to improve functionality of the involved arm were performed at a later stage in 25/58 patients. Outcomes of the secondary functional restorative procedures were evaluated (mean follow-up: 11.5 months; range 3-60 months in 43 procedures).
Results: Patients with neurolysis as a stand alone procedure (11 patients) showed an outcome grade of 4-5. The average outcome of patients with C5, C6 and C7 grafting (19 patients) was grade 3, same as in patients with nerve transfers to the upper plexus elements (C5-6 root avulsions, 13 patients). One child with C8 and T1 avulsion receiving intraplexual transfer showed an outcome of grade 3. Patients with multiple root avulsions (5 cases) had an overall poor outcome (grade 0-2). Secondary functional restorative surgery was required in 43% of the patients, and helped to improve individual outcomes, resulting in a favorable improvement in the general functionality of the arm. Among the functional restorative operations, the Steidler procedure, a restoration of wrist extension, claw hand correction, as well as free functional muscle flaps to the arm and forearm were the most rewarding.
Conclusions: A combination of primary brachial plexus reconstruction, as well as carefully evaluated, selected and planned functional restorative secondary procedures may offer improved outcomes in patients with partial or total brachial plexus lesions.
