Elsevier

World Neurosurgery

Volume 103, July 2017, Pages 28-36
World Neurosurgery

Original Article
Long-Term Outcome of Brachial Plexus Reimplantation After Complete Brachial Plexus Avulsion Injury

https://doi.org/10.1016/j.wneu.2017.03.052Get rights and content
Under a Creative Commons license
open access

Background

Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury.

Objective

We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing.

Methods

We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests.

Results

We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome.

Conclusions

Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair.

Key words

Brachial plexus
Brachial plexus avulsion
Brachial plexus reimplantation surgery

Abbreviations and Acronyms

BP
Brachial plexus
CMAP
Compound muscle action potential
DASH
Disabilities of the Arm, Shoulder, and Hand
EMG
Electromyelography
FDS
Flexor digitorum superficialis
MRC
Medical Research Council
MUAP
Motor unit action potential
PSW
Positive sharp waves
SCV
Sensory conduction velocity
SD
Standard deviation
SF-36
Short Form-36
SNAP
Sensory nerve action potential

Cited by (0)

Conflict of interest statement: We acknowledge research funding from the European Research Council. This work was carried out in part at the University College London Institute of Neurology, which receives funding from the National Institute for Health Research Biomedical Research Centre.