Timing for repair in brachial plexus injury
06 April 2017 (online)
Brachial plexus injuries predominantly target young individuals and result in severe functional impairment in the affected limb. Management of these injuries is challenging and functional gains are often unpredictable. Though there is a general agreement that early repairs result in better functional outcomes, a period of observation, sometimes, will allow a good spontaneous recovery in traction related injuries. Mode of injury will also have a bearing while deciding the timing of repair.
If attempted immediate, direct repair of plexal elements is feasible in clean transections. In late repairs, nerve ends retract and require nerve grafting. Missile injuries and traction induced injuries are observed for spontaneous recovery for a period of up to 3 months. Presence of pseudomeningoceles in MR myelography is an indication for an early surgery. Neurolysis, direct nerve repair, nerve grafting, nerve transfer, pedicle muscle transfer and functioning free-muscle transfer are the main surgical procedures in the management of brachial plexus injuries.
Good results are expected following immediate and direct repair of clean transections in upper plexal elements. Early repairs give better results than delayed repairs in all kinds of brachial plexus lesions.
The timing of repair in brachial plexus injury is dependent on several factors, e.g; the mechanism of injury, type of injury, speed of the vehicle, and the mode of fall while victim lands on the ground. High speed motor cycle accidents usually result in root avulsions and demand an early intervention. Clean transections should be repaired immediately, whereas missile and traction induced injuries should be observed for spontaneous recovery for a period up to 3 months.
- 1 Bhandari P.S., Sadhotra L.P., Bhargava P., Bath A.S., Singh P., Mukherjee M.K.. Microsurgical reconstruction devastating brachial plexus injuries. Ind J Neurotrauma 2005; 02 (01) 35-39
- 2 Songcharoen P.. Management of brachial plexus injuries in adults. Scand J Surg 2008; 97: 317-323
- 3 Alnot J.Y.. Traumatic brachial plexus lesions in the adult. Indications and results. Hand Clin 1995; 11: 623-631
- 4 Bhandari P.S., Sadhotra L.P., Bhargava P., Bath A.S., Mukherjee M.K., Singh P., Langer V.. Management of missile injuries of the brachial plexus. Ind J Neurotrauma 2006; 03 (01) 49-54
- 5 Kline D.G.. Timing for brachial plexus injury: a personal experience. Neurosurg Clin N Am 2009; 20: 24-26
- 6 Kline D.G.. Civilian gunshot wounds to the brachial plexus. J Neurosurg 1989; 70: 166-174