Axillary nerve reconstruction in 176 posttraumatic plexopathy patients

In posttraumatic brachial plexus palsy, shoulder stabilization is of utmost importance before reanimation of the distal upper extremity. The aim of this study was to present the authors' experience with axillary nerve reconstruction in 148 patients with posttraumatic plexopathy. Functional outcomes were assessed and correlated with the following factors: severity score, denervation time, and donor nerve used.

The medical records of 176 patients who underwent axillary nerve reconstruction performed by a single surgeon between 1978 and 2006 were reviewed. The results were analyzed in 148 patients who had adequate follow-up (>24 months). Nerve reconstruction was performed using 94 intraplexus donor nerves and 55 extraplexus donor nerves; axillary-to-axillary repair was performed in 13 patients, and 15 patients had microneurolysis. One hundred forty patients had interposition nerve grafts. A total of 135 patients had concomitant neurotization of the suprascapular nerve.

Results were good or excellent in 45.95 percent of patients. The intraplexus donors yielded significantly better shoulder function than the extraplexus donors. The length of the nerve graft had a direct influence on deltoid recovery. Patients with a severity score higher than 10 attained significantly better results than patients with multiple root avulsions. Surgery earlier than 4 months yielded significantly better functional outcomes than delayed operation of more than 8 months.

Early primary axillary nerve reconstruction offers rewarding glenohumeral joint stability and an acceptable range of shoulder function. Concomitant neurotization of the suprascapular nerve yielded improved outcomes in shoulder abduction and external rotation.