Surgical nerve wrapping for brachial plexus neuropathy: A systematic review

Nerve wrapping provides protection, reduces adhesions, and supports regeneration, with proven benefits in median and ulnar neuropathies. Brachial plexus neuropathies-arising from neurogenic thoracic outlet syndrome (NTOS), radiation-induced brachial plexopathy (RIBP), or trauma-pose distinct challenges, and indications for wrapping remain poorly defined. We conducted a systematic review of brachial plexus wrapping techniques to clarify approaches and outcomes.

PubMed, Scopus, Cochrane Library, and ProQuest were searched following PRISMA guidelines; the protocol was registered on PROSPERO. Risk of bias was assessed with the MINORS tool. Extracted data included patient characteristics, surgical techniques, functional outcomes, complications, and recurrences.

Seventeen studies involving 645 patients (mean age 43.8 years; M/F 1/3.92) were included. The main indications were NTOS (77.1 %) and RIBP (22.6 %). Eleven wrapping techniques were identified: eight different flaps (n = 214) from omental, muscular, or adipofascial origins, and three medical devices (n = 426). NTOS was mainly treated with synthetic membranes, and RIBP with flaps. Pain reduction was reported in 91.9 % of cases, with complete relief in 62.8 %. For RIBP, motor improvement (52.5 %) and sensory improvement (50 %) were observed, while QuickDASH scores for NTOS improved by a mean of 23.3 points. Comparative studies (n = 4) suggest wrapping may outperform neurolysis alone in RIBP.

Brachial plexus wrapping may improve pain and function in selected patients, but current evidence is heterogeneous, retrospective, and at high risk of bias. Standardized, prospective controlled studies are required to determine its role relative to isolated neurolysis.Level of evidence: III.