gms | German Medical Science

Objectives: Root avulsions of the brachial plexus represent one of the most severe nerve injuries. Next to apparent sensorimotor functional deficits avulsion injuries often lead to unbearable pain, frequently referred to as deafferentation pain. In avulsion injuries of the inferior trunk the burden of pain is most intense and the hand function that can be expected by reconstructive, surgical approaches (intra-/extraplexual nerve transfers, nerve grafts) is less than poor. We report of 5 patients with global brachial plexopathies with avulsion of at least one nerve root, who have approached our specialist center of extremity reconstruction in the years of 2010 to 2015. The impact of bionic hand reconstruction on hand function, deafferentation pain and quality of life is presented.

Method: In all 5 patients multiple selective nerve transfers (and muscle transfers in selected cases) were performed on the affected limb. Surgery was not able to restore motor function in the hand but thereby generated electromyographic signals could be used for the control of a prosthetic device. After intense rehabilitative training the functionless hand was electively amputated and replaced by a functional prosthesis, defined as bionic reconstruction.

The patients were evaluated pre-interventionally (before bionic reconstruction), during the rehabilitative process and after amputation as well as prosthetic fitting. The pain state was assessed with the Visual Analogue Scale (VAS). Additionally pre-and post-interventional pain medication was documented and quality of life as well as general health state were assessed on a regular basis (Health Survey SF-36).

Results: In all 5 treated patients bionic reconstruction led to significant pain reduction compared against pre-interventional pain conditions. Pain medication intake was ceased in each patient after the prosthesis had been incorporated into the user's activities of daily living. Quality of life, subjectively perceived health state, and psychological role functioning also improved dramatically.

Conclusion: The functional and cognitive reintegration of the extremity into the patient's body image led to major pain relief as well as markedly improved quality of life in all so far treated patients. In some patients even a re-entry into working life was permitted by the functional gain of the prosthetic hand, which also came along with social and economic benefits.