[Total paralysis of the brachial plexus caused by supra-clavicular lesions]

From 1983 to 1987, 50 adult patients who suffered total palsy of brachial plexus were operated on. The average follow up was 39 months. They suffered severe supra-clavicular lesions of all the roots. All the roots damaged in the scalenic area were grafted, the avulsed ones were not. One root was grafted in 23 patients, two roots in 9 patients, three roots in 5 patients, four roots in 1 patient. No root was grafted in 12 patients. An active flexion of the elbow (over M3+, M4) was recovered in 39 patients (76 per cent). An active adduction of the shoulder (m. pectoralis major) was recovered in 24 patients (48 per cent), and an active abduction (supraspinatus or deltoid) in 13 patients (26 per cent). Twenty seven patients had severe pain before surgery. After grafting, pain decreased in 17 (62 per cent. At follow-up, 31 of the 50 patients had no pain or mild pain. These results justify for the authors nerve repair in total palsy of brachial plexus by supra-clavicular lesions.