title: Total obstetric brachial plexus palsy: results and strategy of microsurgical reconstruction.
abstract: From 2000 to 2006, 35 infants with total obstetric brachial plexus palsy underwent brachial plexus exploration and reconstruction. The mean age at surgery was 10.8 months (range 3-60 months), and the median age was 8 months. All infants were followed for at least 2.5 years (range 2.5-7.3 years) with an average follow-up of 4.2 years. Assessment was performed using the Toronto Active Movement scale. Surgical procedures included neurolysis, neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostals and contralateral C7 root. Satisfactory recovery was obtained in 37.1% of cases for shoulder abduction; 54.3% for shoulder external rotation; 75.1% for elbow flexion; 77.1% for elbow extension; 61.1% for finger flexion, 31.4% for wrist extension and 45.8% for fingers extension. Using the Raimondi score, 18 cases (53%) achieved a score of three or more (functional hand). The mean Raimondi score significantly improved postoperatively as compared to the preoperative mean: 2.73 versus 1, and showed negative significant correlation with age at surgery. In total, obstetrical brachial plexus palsy, early intervention is recommended. Intercostal neurotization is preferred for restoration of elbow flexion. Tendon transfer may be required to improve external rotation in selected cases. Apparently, intact C8 and T1 roots should be left alone if the patient has partial hand recovery, no Horner syndrome, and was operated early (3- or 4-months old). Apparently, intact nonfunctioning lower roots with no response to electrical stimulation, especially in the presence of Horner syndrome, should be neurotized with the best available intraplexal donor.
authors.affiliation: Department of Orthopedics and Traumatology, Reconstructive Microsurgery Unit, Assiut University School of Medicine, Assiut 71526, Egypt. tarek_elgammal@yahoo.com
authors.forename: Tarek A
authors.initials: TA
authors.lastname: El-Gammal
authors.forename: Amr
authors.initials: A
authors.lastname: El-Sayed
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Kotb
authors.forename: Yasser Farouk
authors.initials: YF
authors.lastname: Ragheb
authors.forename: Waleed Riad
authors.initials: WR
authors.lastname: Saleh
authors.forename: Ramy Mohamed
authors.initials: RM
authors.lastname: Elnakeeb
authors.forename: Ahmad
authors.initials: A
authors.lastname: El-Sayed Semaya
mesh_terms: D001720:Birth Injuries / Q000150:complications; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery; D019635:Neurosurgical Procedures; D010246:Paralysis, Obstetric / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D020127:Recovery of Function