Outcomes of hand reconstruction in obstetric brachial plexus palsy.
BACKGROUND
In children with global obstetric brachial plexus palsy, prioritization should be first focused on hand reinnervation and then directed to shoulder and elbow function. In this study, the surgical strategy for restoration of hand function and the methods and outcomes are analyzed.


METHODS
Between 1979 and 2005, 59 patients (61 extremities) underwent reconstruction for hand reanimation. The mean follow-up was 7.7 years (range, 2 to 22 years). Of these, 16 cases underwent primary reconstruction alone, 35 underwent both primary and secondary procedures, and 10 late cases underwent palliative surgery. Hand function was evaluated with a modified Gilbert- Raimondi hand scale (grades 4 to 6 were considered useful outcomes).


RESULTS
Grade 4 or better functional recovery was observed in six of six cases (100 percent) that underwent primary reconstruction within the first 3 months of life. These patients did not require any secondary procedures. Multiple secondary procedures were necessitated to maximize the functional outcome in late cases or in patients with incomplete recovery following primary reconstruction. Overall, 46 of 61 cases (75.4 percent) achieved grade 4 or greater. The long-term results were better; 23 of 26 cases (88 percent) with a follow-up of more than 8 years achieved grade 4 or greater.


CONCLUSIONS
When primary reconstruction was performed within 3 months, functional return to the hand was the greatest and the need for palliative surgery was dramatically reduced. For older patients (>or=4 months), secondary procedures can significantly enhance hand function. The best results were seen when a combination of tendon transfers and free muscles transfers was performed.
Terzis
Julia K
JK
Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School.
Kokkalis
Zinon T
ZT
D000293:Adolescent; D001720:Birth Injuries / Q000601:surgery*; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000294:innervation*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008866:Microsurgery / Q000379:methods*; D009048:Motor Skills / Q000502:physiology; D018482:Muscle, Skeletal / Q000637:transplantation*; D016067:Nerve Transfer / Q000379:methods*; D010166:Palliative Care; D052581:Pinch Strength / Q000502:physiology; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013126:Spinal Nerve Roots / Q000601:surgery; D013709:Tendon Transfer / Q000379:methods*; D055815:Young Adult