Semin Plast Surg 2005; 19(1): 96-102
DOI: 10.1055/s-2005-867115
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Secondary Reconstructive Procedures in Obstetrical Brachial Plexus Palsy: Forearm, Wrist, and Hand Deformities

Panayotis N. Soucacos1 , Marios D. Vekris2 , John Kostas3 , Elizabeth O. Johnson4
  • 1Department of Orthopaedic Surgery, University of Athens, School of Medicine, Athens, Greece
  • 2Orthopaedic Department, Ioannina University Medical School, Ioannina, Greece
  • 3Microsurgical Unit, Eastern Virginia Medical School, Norfolk, Virginia
  • 4Department of Anatomy, Ioannina University Medical School, Ioannina, Greece
Further Information

Publication History

Publication Date:
04 April 2005 (online)

ABSTRACT

Obstetrical brachial plexus paralysis (OBPP) is a complex, multifaceted disorder with potentially disabling sequalae. Although the shoulder is the most frequently affected joint, the forearm, wrist, and hand may also display diabling deformities. In sequalae involving the forearm, the most frequent deformity is supination contractures followed by pronation contractures. Treatment of OBPP has recently focused on early microsurgical repair; nonetheless, palliative surgery still plays a critical role in the overall reconstructive planning in order to diminish the sequalae of OBPP and improve function of the upper extremity. The preferred palliative surgical proceures for the forearm and hand include flexor or extensor tendon transfers, free muscle transfers, opponensplasty, and bone fusion. The most commonly restored functions are elbow flexion and extension, finger flexion and extension, and, in some cases, shoulder abduction and intrinsic substitution.

REFERENCES

  • 1 Erb W H. Uber eine eigentümliche lokalisation von lahmungen in plexusbrachials.  Verhandl Naturhist Med Vereins. 1874;  2 130-136
  • 2 al-Qattan M M, Clarke H M, Curtis C G. The prognostic value of concurrent clavicular fractures in newborns with obstetric brachial plexus palsy.  J Hand Surg [Br]. 1994;  19 729-730
  • 3 Klumpke A. Contribution á l'etude des paralysies radiculaires du plexus brachial.  Rev Méd (Paris). 1885;  5 591-616
  • 4 Terzis J K, Liberson W T, Levine R. Obstetric brachial plexus palsy.  Hand Clin. 1986;  2 773-786
  • 5 Narakas A O. Injuries to the brachial plexus. In: Bora FW Jr The Pediatric Upper Extremity: Diagnosis and Management. Philadelphia; WB Saunders 1986: 247-258
  • 6 Berger A C, Hierner R, Becker M H. Die fruhzeitige mikrochirurgische revision des plexus brachialis bei geburtstraumatischen Lasionen. Patientenauswahl und Ergebnisse.  Orthopade. 1997;  26 710-718
  • 7 Kawabata H, Masada K, Tsuyuguchi Y, Kawai H, Ono K, Tada R. Early microsurgical reconstruction in birth palsy.  Clin Orthop. 1987;  215 233-242
  • 8 Alanen M, Ryoppy S, Varho T. Twenty-six early operations inbrachial birth palsy.  Z Kinderchir. 1990;  45 136-139
  • 9 Birch R, Bonney G, Wynn-Parry C B. Birth lesions of the brachial plexus. In: Sedden H Surgical Disorders of the Peripheral Nerves. Edinburgh; Churchill Livingstone 1998: 209-233
  • 10 Gilbert A, Tassin J L. Reparation chirurgicale du plexus brachial dans la paralysie obstetricale.  Chirurgie. 1984;  110 70-75
  • 11 Zancolli E, Zancolli E. Reconstructive surgery in brachial plexus sequelae. In: Gupta A, Kay SPJ, Scheker LR The Growing Hand: Diagnosis and Management of the Upper Extremity in Children St. Louis, MO; Mosby 2000: 805-823
  • 12 Chuang D CC. Palliative surgery: forearm and hand deformities. In: Gilbert A Brachial Plexus Injuries. Paris; Martin Dunitz 2001: 294-302
  • 13 Zancolli E A. Paralytic supination contracture of the forearm.  J Bone Joint Surg Am. 1967;  49 1275-1284
  • 14 Zancolli E A, Zancolli E R. Palliative surgical procedures in sequelae of obstetrical palsy.  Hand Clin. 1988;  4 643-669
  • 15 Adler J B, Patterson Jr R L. Erb's palsy. Long time results of treatment in eighty-eight cases.  J Bone Joint Surg Am. 1967;  490 1052-1064
  • 16 Doi K. Obstetric and traumatic pediatric palsy. In: Peimer A Surgery of the Hand and Upper Extremity. New York; McGraw-Hill 1996: 1443-1463
  • 17 Hoffer H M. Assessment and natural history of brachial plexus injury in childre. In: Gelberman RH Operative Nerve Repair and Reconstruction Philadelphia; JB Lippincott 1991: 1361-1368
  • 18 Lamb D W. Tendon transfers for paralytic states. In: Barron JN, Saad MN The Hand. Operative Plastic and Reconstructive Surgery. Edinburgh; Churchill-Livingstone 1980: 1163-1177
  • 19 Marshall R W, Williams D H, Birch R, Bonney G. Operations to restore elbow flexion after brachial plexus injuries.  J Bone Joint Surg Br. 1988;  70 577-582
  • 20 Aziz W, Singer R M, Wolff T W. Transfer of the trapezius for flail shoulder after brachial plexus injury.  J Bone Joint Surg Br. 1990;  72 701-704
  • 21 Brunelli G A, Vigasio A, Brunelli G R. Modified Steindler procedure for elbow flexion restoration.  J Hand Surg [Am]. 1995;  20 743-746
  • 22 Manktelow R T, McKee N H. Free muscle transplantation to provide active finger flexion.  J Hand Surg [Am]. 1978;  3 416-426
  • 23 Terzis J K, Sweet R C, Dykes R W, Williams H B. Recovery of function in free muscle transplants using microneurovascular anastomoses.  J Hand Surg [Am]. 1978;  3(1) 37-59
  • 24 Terzis J K, Vekris M D, Soucacos P N. Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis.  Plast Reconstr Surg. 1999;  104(5) 1221-1240
  • 25 Doi K. New reconstructive procedure for brachial plexus injury.  Clin Plast Surg. 1997;  24 75-85
  • 26 Berger A, Becker M. Brachial plexus surgery: our concept of the last twelve years.  Microsurgery. 1994;  15 760-767
  • 27 Gilbert A, Tassin J L. Obstetrical palsy: a clinical, pathologic and surgical review. In: Terzis JK Microreconstruction of Nerve Injuries. Philadelphia; WB Saunders 1987: 529-553
  • 28 Owings R, Wickstrom J, Perry J, Nickel V. Biceps brachii rerouting in treatment of paralytic supination contracture of the forearm.  J Bone Joint Surg [Am]. 1971;  53 137-142
  • 29 Muhlig R S, Blaauw G, Sloof A CJ, Kortleve J W, Tonino A J. Conservative treatment of obstetrical brachial plexus palsy (OBPP) and rehabilitation. In: Gilbert A Brachial Plexus Injuries. Paris; Martin Dunitz 2001: 173-187
  • 30 Green D P. Radial nerve palsy. In: Green D Operative Hand Surgery. 3rd ed. New York; Churchill-Livingstone 1993: 1401-1417
  • 31 Wheeler D R. Reconstruction for radial nerve palsy. In: Peimer A Surgery of the Hand and Upper Extremity. New York; McGraw-Hill 1996: 1363-1379
  • 32 Omer G E. Combined nerve palsies. In: Green D Operative Hand Surgery. 3rd ed. New York; Churchill-Livingstone 1993: 1401-1417
  • 33 Gousheh J, Arab H, Gilbert A. The extended latisimus dorsi muscle island flap for flexion or extension of the fingers.  J Hand Surg [Br]. 2000;  25 160-165
  • 34 Gousheh J. Palliative surgery: the hand. In: Gilbert A Brachial Plexus Injuries. Paris; Martin Dunitz 2001: 131-136

Panayotis N SoucacosM.D. F.A.C.S 

Department of Orthopaedic Surgery, University of Athens, School of Medicine, “K.A.T.” Accident Hospital

2 Nikis Street, 145 61 Kifisia, Athens, Greece

    >