Lacerations to the Brachial Plexus: Surgical Techniques and Outcomes

ABSTRACT

The charts of patients with 201 brachial plexus elements sustaining operative lacerations and managed at Louisiana State University Health Sciences Center (LSUHSC) were reviewed retrospectively. Results for elements injured by sharp transections and undergoing suture repairs performed within 72 hr, as well as secondary suture and secondary graft repairs are documented. Similarly, results for secondary end-to-end suture anastomosis and secondary graft repairs for elements sustaining blunt transections are reviewed. Results for neurolysis, end-to-end suture anastomosis, and graft repairs for plexus elements in continuity despite the laceration injury are reviewed.

Outcomes for the LSUHSC series of brachial plexus lacerations are one of the best of all LSUHSC plexus injuries, even for elements generally viewed as unfavorable for repair. Lesions in continuity with positive nerve action potentials (NAPs) had the best outcomes.

Brachial plexus laceration injury - nerve action potential - neurolysis - nerve graft - nerve repair

REFERENCES

• 1 Narakas A O. The treatment of brachial plexus injuries.  Int Orthop. 1985;  9 29-36
• 2 Birch R, Bonney G, Wynn Parry C B. Traumatic Lesions of the Brachial Plexus. London; Churchill Livingstone 1998
• 3 Dunkerton M C, Boome R S. Stab wounds involving the brachial plexus: a review of operated cases.  J Bone Joint Surg Br. 1988;  70 566-570
• 4 Kline D G, Judice D J. Operative management of selected brachial plexus lesions.  J Neurosurg. 1983;  58 631-649
• 5 Davis G. Commentary.  Br J Sports Med. 2001;  35 363
• 6 Gallen J, Wiss D A, Cantelmo N et al.. Traumatic pseudoaneurysm of the axillary artery: report of three cases and literature review.  J Trauma. 1984;  24 350-354
• 7 Kim D H, Cho Y J, Tiel R L, Kline D G. Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center.  J Neurosurg. 2003;  98 1005-1016
• 8 Kline D G, Hudson A R. Nerve Injuries: Operative Results for Major Nerve Injuries, Entrapments, and Tumors. Philadelphia; W.B. Saunders 1995
• 9 Kline D G. Perspectives concerning brachial plexus injury and repair.  Neurosurg Clin N Am. 1991;  2 151-164
• 10 Lundberg G. Pathophysiology of peripheral nerve trauma. In: Omer GE, Spinner M, Van Beek AL Management of Peripheral Nerve Problems. Philadelphia; W.B. Saunders 1998: 353-363
• 11 Doi K, Tamaru K, Sakai K et al.. A comparison of vascularized and conventional sural nerve grafts.  J Hand Surg Am. 1992;  17 670-676
• 12 Gailliot Jr R V, Core G B. Serratus anterior intercostal nerve graft: a new vascularized nerve graft.  Ann Plast Surg. 1995;  35 26-31
• 13 Koshima I, Okumoto K, Umeda N et al.. Free vascularized deep peroneal nerve grafts.  J Reconstr Microsurg. 1996;  12 131-141