Microsurgical technique in obstetric brachial plexus repair: a personal experience in 200 cases over 10 years^[*]

Abstract

We present our personal operative technique in exposing and repairing obstetric brachial plexus (obp) lesions. This technical description of the operative procedure and the strategic choice for the neurotisations are analysed with special regards on the follow-up of these patients (always performed by the surgeon), the histological quality of the proximal root stumps used for cable grafting, and the general reconstruction principles established in international workshops.

We would like to encourage debate on these detailed considerations wherever they could affect the functional outcome.

• References

• 1 Bahm J, Becker M, Disselhorst-Klug C, Williams S, Meinecke L, Müller H, Sellhaus B, Schröder JM, Rau G. Surgical Strategy in Obstetric Brachial Plexus Palsy: The Aachen Experience. Seminars in Plastic Surgery 2004; 18: 285-299 10.1055/s-2004-837255
• 2 Birch R, Bonney G, Wynn Parry CB. Surgical disorders of the peripheral nerves. Churchill Livingstone; Edinburgh: 1998
• 3 Birch R, Ahad N, Kono H, Smith S. Repair of obstetric brachial plexus palsy: Results in 100 children. J Bone Joint Surg 2005; 87B: 1089-1095
• 4 Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clinics 1995; 11 (4) 583-595 8567740
• 5 Waters PM. Update on management of pediatric brachial plexus palsy. J Pediatric Orthopaedics B 2005; 14: 233-244
• 6 Bisinella GL, Birch R, Smith SJM. Neurophysiological prediction of outcome in obstetric lesions of the brachial plexus. J Hand Surg 2003; 28B [phone]
• 7 Wolock B, Millesi H. Brachial Plexus – Applied anatomy and operative exposure. Gelberman RH. Operative nerve repair and reconstruction. Lippincott; Philadelphia: 1991
• 8 Bahm J, Wein B, Al Hares G, Dogan C, Radermacher K, Schuind F. Assessment and treatment of glenohumeral joint deformities in children suffering from upper obstetric brachial plexus palsy. J Ped Orthopaedics 2007;
• 9 Clarke HM, Al-Qattan MM, Curtis CG, Zuker RM. Obstetrical brachial plexus palsy – Results following neurolysis of conducting neuromas-in-continuity. Plast Reconstr Surg 1996; 97: 974-984 8619001