BRACHIAL-PLEXUS SURGERY - OUR CONCEPT OF THE LAST 12 YEARS

In patients with brachial plexus injuries restoration of complete func tion is seldom seen. The diagnosis is a clinical one; investigations s uch as MRI or myelography are not sufficiently reliable to base surgic al indications on them. Surgery has to be performed within the first s ix months after the trauma. The surgical procedure firstly includes an exact intraoperative definition of the extent of the lesion. Dependin g on the type of the lesion, microsurgical neurolysis, nerve grafting, or reneurotization is performed. When regeneration is complete, secon dary operations may follow if necessary as part of our integrated conc ept. The spectrum of secondary operations in our patients includes art hrodesis, tenodesis, tendon transfers, muscle transfers, and free neur ovascular tissue transfer. In selected cases with extensive lesions a bifunctional latissimus dorsi transfer allows restoration of minimal g rip with simultaneous elbow flexion. Our concept includes a series of hierarchical steps: 1. Diagnosis and indication 2. Nerve repair 3. Int ensive physiotherapy, control in intervals 4. Secondary operations-if necessary 5. Intensive physiotherapy 6. Ergotherapy, orthosis In the l ast 12 years 362 patients with brachial plexus lesions have been opera ted on in our clinic. In these patients we performed 104 neurolyses, 1 26 nerve grafting procedures, 87 reneurotizations, and 191 secondary o perations in 96 patients. Only the combination of nerve repair with bo th conventional and newer methods of tendon and muscle transfers can r estore the maximum function for the individual situation. (C) 1994 Wil ey-Liss, Inc.