Brachial plexus lesions: 10 years of experience in a center for microsurgery in Germany

Brachial plexus lesions are commonly associated with complete or partial plegia of affected muscles even after microsurgical treatment. This study provides an overview of strategies and outcomes of 42 patients operated in a center for peripheral nerve surgery in Germany.

Postsurgically, the patients were followed up and examined for strength in various muscle groups by applying a standard clinical classification (M0-M5). Sensitivity was estimated by differentiation between blunt and sharp touch. The patients were asked via questionnaire about their postsurgical daily life. Most of the patients received a grafting procedure using the sural nerve. Different microsurgical techniques were applied according to the underlying pathology: Intercostal nerve transfer, end-to-side coaptation, and direct grafting to different recipient nerves.

Only the 27 patients, who had a follow-up time of at least 36 months, presented a measurable function in the affected extremity. Elbow-flexion was restored in 15 cases. Triceps function was reconstructed in 7 patients of 27. One patient was able to move digits toward the palm without completing a full fist. Ten patients were able to flex the wrist and 4 could extend it.

The results were estimated as acceptable for biceps reconstruction but poor for the other muscle groups. Some treatment strategies, which are presently under frequent discussion (contralateral C7-transfer, banked autografts, Oberlin procedure), were not applied. However, some of these techniques may provide a key to improve the results.