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[Early microsurgical treatment of upper obstetrical brachial plexus injury]
Qing-han Chen1, De-song Chen, You-sheng Fang
1Department of Orthopedic Surgery, Second Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, P. R. China 450014.
Insights
Microsurgical operations for obstetrical brachial plexus injury (OBPI) yield good results, especially when performed between 3-6 months. Neurolysis and nerve coaptation are preferred over neurotization for better outcomes in infants.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Microsurgery
Context:
- Obstetrical brachial plexus injury (OBPI) is a significant concern in neonatology.
- Early intervention is crucial for improving functional outcomes in affected infants.
- Microsurgical techniques offer potential for nerve repair and functional recovery.
Purpose:
- To evaluate the optimal timing and surgical methods for treating obstetrical brachial plexus injury (OBPI).
- To compare the efficacy of different microsurgical procedures in infants with OBPI.
- To determine the age threshold for effective surgical intervention in OBPI.
Summary:
- A study of 32 infants with upper OBPI treated with microsurgery between 3-24 months showed a 76.7% excellent/good outcome rate.
- Infants operated on before 6 months demonstrated superior results compared to those operated on after 6 months.
- Procedures like neurolysis and nerve coaptation were found to be more effective than neurotization.
Impact:
- Suggests that microsurgical intervention for OBPI should be considered as early as 3-6 months in infants with limited elbow flexion.
- Highlights the superiority of neurolysis and nerve coaptation over neurotization for OBPI treatment.
- Emphasizes the importance of selecting surgical procedures based on intraoperative findings for optimal patient outcomes.
Objective:
To search for the operation timing and methods for obstetrical brachial plexus injury (OBPI).
Methods:
Thirty-two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis(n = 12), coaptation after resection of the neuroma without function (n = 7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve (n = 7) and intercostal nerves transfer to musculocutaneous nerve(n = 6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture.
Results:
Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7% (23/30). The results of the children under 6 months were better than those over 6 months.
Conclusion:
The microsurgical operation might be considered at the age of 3-6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.
