Intraoperative brachial plexus injuries during reconstruction of the burned axilla

Since opening of the Shriners Burns Institute, Cincinnati Unit, 501 operations for release of burn scar-related contractures of the axilla have been carried out with skin grafting. Six of these cases, 1.2%, resulted in intraoperative stretch injuries to the brachial plexus. In two cases, isolated axillary nerve involvement was encountered. In four cases, additional diffuse injury to the brachial plexus was present. Intraoperative motion and postoperative splinting in a position of abduction were believed to be possible etiological agents. Prompt removal of the splint and institution of physical therapy were carried out. In all cases, there was full return of neurologic function. Indications for surgery were preoperative limitation of abduction at the shoulder due to scar in five cases; one operation was performed for cosmetically disfiguring webbing. Final range of motion, 1 year postoperatively, was normal in all cases. Time to full recovery varied from 2 to 9 months. The importance of preventing the problem by keeping intraoperative motion to a minimum and checking neurologic function promptly in the postoperative period is stressed.