Surgical strategy in extensive proximal brachial plexus palsies

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Reconstructive Surgery

Background:

• Extensive proximal brachial plexus injuries (BPI) present complex reconstructive challenges.
• Restoring function after severe BPI requires a comprehensive surgical approach.

Purpose of the Study:

• To describe and assess a unified surgical strategy for extensive proximal brachial plexus injuries (BPI).
• Evaluate the efficacy of nerve transfers, grafts, and tendon transfers in BPI management.

Main Methods:

• Retrospective review of 45 patients with C5-C8 BPI.
• Surgical interventions included nerve transfers for elbow flexion, grafts for shoulder function, and tendon transfers for finger extension.
• Palliative shoulder procedures and humeral osteotomy were employed when primary nerve surgery was not feasible or failed.

Main Results:

• Elbow flexion reanimation achieved grade-3 strength in 90% of patients (37/41) via nerve or tendon transfers.
• Elbow extension recovery showed grade-3/4 strength in 86% (25/29) following nerve transfers.
• Shoulder abduction/rotation recovery was achieved in 73% (30/41) of patients.
• Finger extension was successfully restored in 95% (35/37) of cases.

Conclusions:

• A standardized surgical strategy can yield satisfactory functional outcomes for extensive proximal BPI.
• The described approach effectively addresses multiple functional deficits in BPI patients.