[Intercostal nerve cross-anastomosis and DREZ-tomy in a patient with brachial plexus avulsion].
An 18-year-old male with a right brachial plexus injury caused by a motorcycle accident was admitted on October 13, 1988. A detailed examination revealed that the brachial plexus was totally injured. The axon reflex test suggested that the lesion sites were postganglionic in the C5 and C6 nerves, and preganglionic in the C7, C8 and Th1. On December 14, 1988, intercostal nerve cross-anastomosis was performed in the hope that a lost motor function of the right upper extremity could be restored as a first step. An electromyogram 6 months after this anastomotic operation demonstrated synkinesis between the biceps brachialis and the intercostal muscles during deep inspiration. Fifteen months after this operation, active voluntary muscle discharges which were higher than before in amplitude, were provoked. The right elbow flexion was gradually restored independently of respiration. On the other hand, intractable pain with a persistent severe tingling sensation appeared approximately one week after the injury on the lesioned upper extremity. The pain rapidly increased in severity. The DREZ-tomy from C5 to Th1 was performed on March 7, 1989. This has brought complete relief of the intractable pain. A brief discussion was given concerning some aspects of the brachial plexus avulsion and DREZ-tomy.
Sakai
K
K
Department of Neurosurgery, Okayama Rosai Hospital.
Sasayama
H
H
Morooka
H
H
Namba
S
S
D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D001917:Brachial Plexus / Q000293:injuries*; D005727:Ganglia, Spinal / Q000601:surgery; D015171:Ganglionectomy; D006801:Humans; D007367:Intercostal Nerves / Q000601:surgery*; D008297:Male