title: Long-Term Outcome of Brachial Plexus Reimplantation After Complete Brachial Plexus Avulsion Injury.
abstract: BACKGROUND
  Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury.
  
  
  OBJECTIVE
  We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing.
  
  
  METHODS
  We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests.
  
  
  RESULTS
  We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome.
  
  
  CONCLUSIONS
  Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair.
authors.affiliation: Spinal Repair Unit, UCL Institute of Neurology, London, England, United Kingdom. Electronic address: carolina.kachramanoglou@nhs.net.
authors.forename: Carolina
authors.initials: C
authors.lastname: Kachramanoglou
authors.affiliation: Spinal Repair Unit, UCL Institute of Neurology, London, England, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Carlstedt
authors.affiliation: Spinal Repair Unit, UCL Institute of Neurology, London, England, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Koltzenburg
authors.affiliation: Spinal Repair Unit, UCL Institute of Neurology, London, England, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D001132:Arm; D001917:Brachial Plexus / Q000293:injuries / Q000601:surgery*; D004576:Electromyography; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation; D059348:Peripheral Nerve Injuries / Q000601:surgery*; D020127:Recovery of Function; D012092:Replantation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000294:innervation; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brachial plexus; Brachial plexus avulsion; Brachial plexus reimplantation surgery