Late reconstruction for brachial plexus injury.

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Microsurgery

Background:

• Traumatic brachial plexus injuries present significant management challenges.
• A multidisciplinary approach is essential for optimal patient outcomes.
• Delayed presentation or failure of primary reconstruction necessitates secondary procedures.

Purpose of the Study:

• To outline primary and secondary surgical reconstruction techniques for traumatic brachial plexus injuries.
• To detail the principles and critical aspects of these reconstructive procedures.
• To emphasize the goals of restoring elbow flexion, shoulder stability, and prehension.

Main Methods:

• Primary reconstruction: nerve repair, nerve grafting, and nerve transfers.
• Secondary reconstruction: microneurovascular free-functioning muscle transfer (FFMT), tendon transfers, and arthrodesis.
• Focus on functional restoration for elbow flexion, shoulder stability, and hand prehension.

Main Results:

• Primary techniques address immediate nerve deficits.
• Secondary techniques, including FFMT, are vital for late reconstruction (>12 months) or failed primary repairs.
• Specific FFMT strategies enhance elbow flexion and prehension; shoulder reconstruction targets glenohumeral stability and abduction.

Conclusions:

• Surgical management of brachial plexus injuries involves distinct primary and secondary phases.
• Free-functioning muscle transfers are key for restoring elbow flexion and hand function in secondary reconstruction.
• Restoring shoulder stability and abduction is crucial for overall upper extremity function.