Outcomes of Reconstructive Surgery in Traumatic Brachial Plexus Injury with Concomitant Vascular Injury
Alice E Huang1, Shelley S Noland2, Robert J Spinner3
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurgery
|December 15, 2019
Summary
Adults with traumatic brachial plexus injury and vascular lesions undergoing reconstructive surgery had worse functional outcomes. Specifically, vascular injury patients showed reduced elbow flexion and shoulder abduction strength compared to controls.
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Traumatology
Background:
- Traumatic brachial plexus injury (AT-BPI) can involve complex neurovascular damage.
- Reconstructive surgery aims to restore function in patients with AT-BPI.
- The impact of concomitant vascular lesions on surgical outcomes is not fully understood.
Purpose of the Study:
- To investigate functional outcomes after reconstructive surgery in adult patients with traumatic brachial plexus injury.
- To compare outcomes between patients with and without associated vascular lesions.
Main Methods:
- Retrospective review of 325 adult patients with AT-BPI undergoing reconstructive surgery (2001-2012).
- Patients were categorized into vascular and control groups based on the presence of vascular injuries.
- Analysis of prognostic variables, surgical management, and long-term functional outcomes including muscle strength and patient-reported disability.
Main Results:
- Sixty-eight patients had concomitant vascular injuries, often presenting with pan-plexus and upper extremity lesions.
- Vascular patients underwent more nerve grafting, while control patients had more nerve transfers.
- While disability scores were similar, vascular patients showed significantly lower postoperative elbow flexion (43% vs. 73%) and shoulder abduction strength compared to controls.
Conclusions:
- Concomitant vascular injury in adult traumatic brachial plexus injury negatively impacts functional recovery after reconstructive surgery.
- Vascular lesions are associated with poorer outcomes in elbow flexion and shoulder abduction strength.
- Surgical strategies may need to be tailored for patients with combined neurovascular injuries.
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