Secondary surgery following brachial plexus injuries

Area of Science:

• Orthopedics
• Neurosurgery
• Reconstructive Surgery

Background:

• Post-traumatic brachial plexus lesions present complex challenges in functional restoration.
• A significant percentage of patients require secondary surgical interventions to regain lost function.

Purpose of the Study:

• To report on the treatment strategies and outcomes for post-traumatic brachial plexus lesions.
• To evaluate the efficacy of various secondary surgical procedures for functional recovery.

Main Methods:

• Review of 362 cases of post-traumatic brachial plexus lesions over 12 years.
• Analysis of secondary operations including arthrodesis, tenodesis, musculotendinous transfers, and free neurovascular tissue transfers.
• Specific evaluation of trapezius transfer, latissimus dorsi transfer, triceps-to-biceps transfer, Steindler flexorplasty, and serratus muscle transfer.

Main Results:

• Secondary operations were needed in 25% of patients.
• Various tendon transfers and tissue transfers demonstrated effectiveness in restoring shoulder and elbow function.
• Strength outcomes varied by procedure: unipolar latissimus dorsi transfer (10-15 kg), bipolar latissimus/triceps-to-biceps transfer (5-8 kg), epitrochlear mass transfer (2-5 kg), and free neurovascular latissimus dorsi transfer (1-4 kg).
• Secondary procedures for lower arm and hand function included nerve transfers and wrist stabilizations.

Conclusions:

• Secondary surgical interventions are crucial for optimizing functional outcomes in brachial plexus injuries.
• The choice of specific reconstructive technique influences the degree of strength recovery.
• A comprehensive approach involving various transfers and grafts addresses diverse functional deficits.