Obstetrical brachial plexus palsy.
In this article, the authors review their approach to evaluation, operative management, and reconstructive technique. Brachial plexus injuries in the newborn are usually managed nonoperatively. The timing and indications for primary surgery vary significantly between institutions. The motor examination is used to determine which infants would benefit from operative management. Patients are selected based on established criteria, such as the Toronto Test Score, applied at age 3 months. However, some cases are initially less clear, and we may recommend delaying operative management until age 6 months or as late as age 9 months if the child fails the cookie test. Neuroma excision, sural nerve grafting, and nerve transfers are performed when indicated by clinical motor examination. The use of selective motor nerve transfers, either in combination with nerve grafting or alone, has allowed nerve coaptations to be performed closer to the neuromuscular junction, which may further improve regeneration. Children undergoing primary surgery experience low rates of perioperative morbidity, and they experience gains in motor function until 3 or 4 years postoperatively, at which point recovery stabilizes.
Borschel
Gregory H
GH
St. Louis, Mo.; and Toronto, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, the Division of Plastic and Reconstructive Surgery, St. Louis Children's Hospital, the Division of Plastic Surgery, The Hospital for Sick Children, and the Department of Surgery, University of Toronto.
Clarke
Howard M
HM
D001720:Birth Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D001724:Birth Weight; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D016067:Nerve Transfer; D019635:Neurosurgical Procedures; D010808:Physical Examination; D011182:Postoperative Care; D012307:Risk Factors