Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons.
OBJECTIVE
Brachial plexus injuries (BPIs) are often devastating events that lead to upper-extremity paralysis, rendering the limb a painful extraneous appendage. Fortunately, there are several nerve repair techniques that provide restoration of some function. Although there is general agreement in the medical community concerning which patients may benefit from surgical intervention, the actual repair technique for a given lesion is less clear. The authors sought to identify and better define areas of agreement and disagreement among experienced peripheral nerve surgeons as to the management of BPIs.


METHODS
The authors developed a detailed survey in two parts: one part addressing general issues related to BPI and the other presenting four clinical cases. The survey was mailed to 126 experienced peripheral nerve physicians and 49 (39%) participated in the study. The respondents represent 22 different countries and multiple surgical subspecialties. They performed a mean of 33 brachial plexus reconstructions annually. Areas of significant disagreement included the timing and indications for surgical intervention in birth-related palsy, treatment of neuroma-in-continuity, the best transfers to achieve elbow flexion and shoulder abduction, the use of intra- or extraplexal donors for motor neurotization, and the use of distal or proximal coaptation during nerve transfer.


CONCLUSIONS
Experienced peripheral nerve surgeons disagree in important ways as to the management of BPI. The decisions made by the various treating physicians underscore the many areas of disagreement regarding the treatment of BPI, including the diagnostic approach to defining the injury, timing of and indications for surgical intervention in birth-related palsy, the treatment of neuroma-in-continuity, the choice of nerve transfers to achieve elbow flexion and shoulder abduction, the use of intra- or extraplexal donors for neurotization, and the use of distal or proximal coaptation during nerve transfer.
Belzberg
Allan J
AJ
Department of Neurological Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287-7509, USA. belzberg@jhu.edu
Dorsi
Michael J
MJ
Storm
Phillip B
PB
Moriarity
John L
JL
D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D000328:Adult; D001132:Arm / Q000294:innervation*; D001720:Birth Injuries / Q000503:physiopathology / Q000601:surgery; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D003288:Contusions / Q000503:physiopathology / Q000601:surgery*; D003625:Data Collection; D004576:Electromyography; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation*; D016067:Nerve Transfer / Q000379:methods; D009463:Neuroma / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010043:Outcome and Process Assessment, Health Care; D010291:Paresis / Q000503:physiopathology / Q000601:surgery*; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000534:rehabilitation*; D012050:Rehabilitation, Vocational; D012782:Shoulder / Q000294:innervation*; D013126:Spinal Nerve Roots / Q000293:injuries / Q000601:surgery; D013180:Sprains and Strains / Q000503:physiopathology / Q000601:surgery*