Current trends in the management of brachial plexus injuries

PS Bhandari; LP Sadhotra; P Bhargava; AS Bath; MK Mukherjee; Pauline Babu

doi:10.1016/S0973-0508(08)80024-X

Indian Journal of Neurotrauma, Table of Contents

Indian Journal of Neurotrauma 2008; 05(01): 21-25
DOI: 10.1016/S0973-0508(08)80024-X

Review Article

Thieme Medical and Scientific Publishers Private Ltd.

Current trends in the management of brachial plexus injuries

Authors

PS Bhandari
LP Sadhotra
P Bhargava
AS Bath
MK Mukherjee
Pauline Babu

Subject Editor:

Abstract

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Abstract

In the last decade several advances have been added in the reconstruction of devastating brachial plexus injuries. This includes better understanding of the anatomy, advances in the imaging techniques, use of newer materials for nerve coaptation (e.g., fibrin glue), introduction of nerve conduits, incorporation of new immunosuppressive agents such as FK-506 and addition of new nerve transfers which selectively neurotize the target muscles close to the motor end plates. These new techniques have considerably improved the results of brachial plexus reconstruction, in particular, the upper plexal lesions.

Keywords

brachial plexus injuries - nerve repair - selective neurotization - nerve conduits - fibrin glue

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References

References
1 Murphey F, Hartung W, Kirkin J W. Myelographic demonstration of avulsing injury of the brachial plexus. Arn J Roengenol 58 1947; 102-105
2 Terzis JK, Papakonstantinou KC. The surgical treatment of brachial plexus injuries in adults. Plast Reconstr Surg 106 2000; 1097-1122
3 Tung THH, Mackinnon SE. Brachial plexus injuries. Clin Plastic Surg 30 2003; 269-287
4 Nakamura T, Yabe Y, Horiuchi Y, Takayarra S. Magnetic resonance myelography in brachial plexus injury. J Bone Joint Surg (Br) 79 1997; 764-769
5 Francel PC, Koby M, Park TS. et al Fast spin-echo magnetic resonance imaging for radiological assessment of neonatal brachial plexus injuries. J Neurosurg 83 1995; 461-466
6 Millesi H. Surgical management of brachial plexus injuries. J Hand Surg. (Am). 02 1977; 367
7 Belzberg AJ, Dorsi MJ, Storm PB, Morlarity JL. Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons. J Neurosurg 101 2004; 365-376
8 Taylor G, Ham F. The free vascularized nerve graft. Plast Reconstr Surg 57 1976; 413-426
9 Bonney G, Birch R, Jamieson A. et al Experience with vascularized nerve grafts. In Terzis J. (editor) Microreconstruction of nerve injuries. 1986. W B Saunders; Philadelphia: 403
10 DOi K, Kuwata N, Kawakami F. et al The free vascularized sural nerve graft. Microsurgery 05 1984; 175-184
11 Hasegawa T, Nakamura S, Manable T. et al Vascularized nerve grafts for the treatment of large nerve gaps after trauma to an upper extremity. Arch Orthop Trauma Surg 124 2004; 209-213
12 Waikakul S, Orapin S., Vanadurongwan V. Clinical results of contralateral C7 root neurotization to the mediam nerve in brachial plexus injuries with total root avulsion. J Hand Surg (Br) 24 1999; 556-560
13 Park SB, Cheshier S, Michaels D, Murovic JA, Kim DH. Endoscopic harvesting of the sural nerve graft: technical note. Neurosurgery 2006; 58 [ONS supp 1 ] : ONS – 180.
14 Mackinnon SE, Doolabh RB, Novak CB, Trulock EP. Clinical outcome following nerve allograft transplantation. Plast Reconstr Surg 107 2001; 1419-1429
15 Jones JW, Gruber SA, Baker JH, Breidenbach WC. Successful hand transplantation. One year follow up. Louisville Hand transplant team. N Eng J Med 243 2000; 468-473
16 Gold BG, Katoch K, Storm-Dickerson T. The immunosuppresant FK 506 increases the rate of axonal regeneration in rat sciatic nerve. J Neurosci 15 1995; 7505-7516
17 Bhandari PS, Sadhotra LP, Bhargava P, Bath AS, Mukherjee MK, Bavdekar RD. What is new in peripheral nerve repair. Ind J Neurotrauma 04 2007; 21-23
18 Narakas A. The use of fibrin glue in repair of peripheral nerves. Orthop Clin North Am 19 1988; 187-198
19 Ornelas L, Padilla L, Di Silvio M, Schalch P, Esperantes RL, Infante. Bustamante JC, Avalos P, Varela D, Lopez M. Fibrin glue: an alternative technique for nerve coaptation – part II Nerve regeneration and histomorphometric assessment. J Reconstr Microsurg 22 2006; 123-128
20 Hudson TW, Evans GR, Schmidt CE. Engineering strategies for peripheral nerve repair. Orthop Clin North Am 31 2000; 485-497
21 Ashley WW, Weatherly T, Park TS. Collagen nerve guides for surgical repair of brachial plexus birth injury. J Neurosurg. 10 2006; 452-456
22 Oberlin C, Beal D, Leechavengvongs S. et al Nerve transfer to biceps muscle using part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg 19 A 1994; 232-237
23 Narakas A, Hentz V. Neurotization in brachial plexus injuries: indication and results. Clin Orthop 237 1988; 43-56
24 Thomear RTWM, Malessy MJA. Surgical repair of brachial plexus injury. Clin Neurol Neurosurg 95 1993; 65-72
25 Narakas AO. Thoughts on neurotization or nerve transfer in irreparable nerve lesions. Clin Plast Surg 11 1984; 153-159
26 Merrel GA, Barrie KA, Katz DL. et al Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg 26 2001; 303-314
27 Samardzic M, Rasulic L, Grujicic D. et al Results of nerve transfer to the musculocutaneous and axillary nerves. Neurosurgery 46 2000; 93-103
28 Nagano A, Yamamoto S, Mikami Y. Intercostal nerve transfer to restore upper extremity functions after brachial plexus injury. Ann Acad Med Singapore 24 Suppl (Suppl. 04) 1995; 42-45
29 Songcharoen P, Mahaisavariya B, Chotigavanich C. Spinal accessory neurotization for restoration of elbow flexion in avulsion injuries of the brachial plexus. J Hand Surg 21 1996; 387-390
30 Carlstedt TP, Anand P, Hallin R, Misra PV, Noren G, Seferlis T. Spinal nerve root repair and reimplantation ofk avuled ventral roots into the spinal cord after brachial plexus injury. J Neurosurg. 93 2000; 237-242