title: Surgical strategies for brachial plexus polio-like paralysis.
abstract: BACKGROUND
  Brachial plexus polio-like paralysis is an acute flaccid paralysis of the upper limb following viral infection. Surgical approaches to the paralytic limb have not previously been discussed in the literature. This study is the first to describe the clinical course and propose a surgical strategy for disabilities related to poliomyelitis-like paralysis.
  
  
  METHODS
  Between 1982 and 2004, 17 patients (11 boys and six girls) presented with acute flaccid paralysis of the upper limb. Their clinical course was reviewed retrospectively. Average age at onset of disease was 2 years (range, 4 months to 13 years). All patients had disability in shoulder abduction and/or elbow flexion. Ten patients underwent reconstructive surgery.
  
  
  RESULTS
  Stage V shoulder abduction (>160 degrees) according to Gilbert's classification was regained in five patients who underwent nerve transfer within 1 year of paralysis. One patient treated by nerve transfer after 3 years of paralysis obtained only stage I abduction (<45 degrees). In two patients, multiple local muscle transfers were performed for the shoulder abduction disability, resulting in mild improvement from stage I to stage II abduction (<90 degrees). In four patients, functioning free muscle transplantation for elbow flexion was carried out, and all regained functional M4 muscle strength. Of seven patients in the nonsurgical group, two had complete spontaneous recovery within 1 year, but five had permanent residual limb paralysis at a mean follow-up of 10 years.
  
  
  CONCLUSIONS
  Surgical strategies, including nerve transfer for shoulder abduction deficit within 1 year after attack and functioning free muscle transplantation for the elbow flexion deficit in the late period, should be considered for this disease. Late reconstruction, either by nerve transfer or by using local multiple muscle transfer for shoulder abduction, is ineffective.
authors.affiliation: Taipei-Linkou, Taiwan From the Department of Plastic Surgery, Chang Gung Memorial Hospital.
authors.forename: Han-Tsung
authors.initials: HT
authors.lastname: Liao
authors.forename: David Chwei-Chin
authors.initials: DC
authors.lastname: Chuang
authors.forename: Ali Engin
authors.initials: AE
authors.lastname: Ulusal
authors.forename: Christiaan
authors.initials: C
authors.lastname: Schrag
mesh_terms: D000293:Adolescent; D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004769:Enterovirus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016067:Nerve Transfer; D019637:Orthopedic Procedures; D016059:Range of Motion, Articular; D012189:Retrospective Studies