Direct Nerve Sutures in (Extended) Upper Obstetric Brachial Plexus Repair

Area of Science:

• Pediatric Surgery
• Neurology
• Orthopedics

Background:

• Obstetric brachial plexus palsy (OBPP) is a rare condition affecting newborns.
• Severe cases may require surgical intervention for improved outcomes.

Purpose of the Study:

• To present a surgical technique for direct nerve coaptation in severe OBPP.
• To evaluate the preliminary functional results of this technique.

Main Methods:

• Prospective open series of 22 patients operated between 2009 and 2016.
• Surgical technique involved direct nerve coaptation with tolerable tension.
• Functional outcomes assessed using the British Medical Research Council (BMRC) scale after a minimum of 18 months.

Main Results:

• All children achieved 60-90° elbow flexion and 75° shoulder abduction by six months post-surgery.
• Mean active shoulder abduction reached 92° at one year and 124° at 18 months post-surgery.
• The study discusses nerve coaptation under reasonable tension, including its benefits and limitations.

Conclusions:

• Direct nerve coaptation may be indicated for selected cases of severe upper OBPP.
• The technique demonstrated good functional results in the studied patient cohort.