Intraoperative Assessment of Nerve Traction Injury in Obstetric Brachial Plexus Palsy

We present an easy classification for nerve lesions observed in reconstructive surgery for obstetric brachial plexus palsy, performed through a supraclavicular approach and systematic exposure of nerve roots and trunks. A description of signs related to nerve traction injury (scarring, fascicular rupture, and dislocated ganglions) is combined with a grading system of microscopic tissue changes occurring in slices from traumatized nerve endings (fascicular structure, changes in perineurium and endoneurium). Both tools are proposed for any surgical brachial plexus exploration and later interaction with other professionals (pediatricians, physiotherapists, or obstetricians).