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[Birth-related brachial plexus paralysis]
1Klinik für Plastische und Handchirurgie, Ferdinand Sauerbruch Klinikum, Klinikum Wuppertal GmbH.
According to the literature, in Europe 0.4-1.2 cases of obstetrical plexus brachial paresis occur per 1000 births. A 4-6 times higher energy in axial delivery of the newborn leads to a neurotmesis of the plexus. If the energy used is more than 10 times higher, root avulsion occur. Early operative therapy for obstetrical plexus paresis is mandatory. The best period for an operation is between the 3rd and 6th months of age. CT and MRI imaging as well as electrophysiological investigations are of the utmost importance. Birch, Gilbert and Gu think there is an indication for operation if no active elbow flexion can be performed at the age of 6 months. Primary coaptation is easier in babies than in adults. However, large defects have to be a bridged by autologous nerve grafts. For root avulsions, neurotization with the accessory and phrenic nerves (Gu) is being used more and more. In 362 children with 52 operated cases, after a follow-up from 2 to 10 years, we found 37 functional, useful recoveries. Nine operations were unsatisfactory and two had poor results. In four cases the operation was unnecessary.
According to the literature, in Europe 0.4-1.2 cases of obstetrical plexus brachial paresis occur per 1000 births. A 4-6 times higher energy in axial delivery of the newborn leads to a neurotmesis of the plexus. If the energy used is more than 10 times higher, root avulsion occur. Early operative therapy for obstetrical plexus paresis is mandatory. The best period for an operation is between the 3rd and 6th months of age. CT and MRI imaging as well as electrophysiological investigations are of the utmost importance. Birch, Gilbert and Gu think there is an indication for operation if no active elbow flexion can be performed at the age of 6 months. Primary coaptation is easier in babies than in adults. However, large defects have to be a bridged by autologous nerve grafts. For root avulsions, neurotization with the accessory and phrenic nerves (Gu) is being used more and more. In 362 children with 52 operated cases, after a follow-up from 2 to 10 years, we found 37 functional, useful recoveries. Nine operations were unsatisfactory and two had poor results. In four cases the operation was unnecessary.