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[Primary reconstructive operation in surgical treatment of perinatal brachial plexus palsy in children]
Małgorzata Chochowska1, Marta Mielcarska, Małgorzata Zgorzalewicz-Stachowiak
1Pracownia Elektrodiagnostyki Medycznej, Katedra Profilaktyki Zdrowotnej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu. chochoma@amp.edu.pl
Insights
Perinatal brachial plexus palsy (PBPP) treatment involves conservative and surgical options. Controversies exist regarding optimal surgical timing and methods for best patient outcomes.
Area of Science:
- Neurology
- Pediatric Surgery
- Microsurgery
Context:
- Perinatal brachial plexus palsy (PBPP) is a significant pediatric medical issue.
- Treatment strategies include conservative management and surgical interventions.
- Surgical approaches are categorized into primary (early-life nerve repair) and secondary (late-life functional correction).
Purpose:
- To review and discuss the surgical treatment modalities for perinatal brachial plexus palsy.
- To highlight the controversies surrounding surgical timing and patient selection criteria.
- To outline various microsurgical techniques employed in PBPP reconstruction.
Summary:
- PBPP treatment encompasses conservative and operative procedures, with surgery divided into primary and secondary interventions.
- Microsurgical techniques like neurolysis, nerve suture, and nerve grafts are utilized.
- Complex cases involving root avulsion may require neurotization, connecting avulsed roots to cervical plexus nerves.
Impact:
- Addressing controversies in surgical timing and method selection is crucial for optimizing functional outcomes in PBPP patients.
- Microsurgical reconstruction aims to improve nerve function and mitigate long-term complications.
- Informed decision-making regarding surgical intervention balances potential benefits against risks for affected children.
Abstract:
Perinatal brachial plexus palsy (PBPP) constitutes a serious medical problem. PBPP treatment consists in conservative and operative procedures. The latter one is usually divided into primary operative procedures, conducted in the initial stage of child's life (aiming at suture of brachial plexus nerves in the early stage of life) and secondary (aiming at elimination of functional limitations, osseous deformations, articular contractures occuring at later stages of life). A significant but also controversial aspect arises at determining the date of operation performance and also at defining factors classifying a child for surgical operation and details concerning the application of definite operative method. The following microsurgical methods are applied in microsurgical reconstruction of PBPP: neurolysis (external and internal), end-to-end nerve suture, free nerve grafts. The most complicated are injuries which result in root avulsion from the spinal medulla. In such cases the avulsed roots are connected to nerves of cervical plexus, applying the method of neurotization. The reason of numerous controversies around the choice of treatment method for PBPP patients is the desire to balance procedures aiming at the proper functioning of the patient in future.
