Complete traumatic brachial plexus palsy - Treatment and outcome after repair

Seventy-eight patients who had a complete brachial plexus palsy caused by a stretching injury were operated on by the same surgeon between January 198 0 and December 1991, The aim of the operative intervention was to obtain th e best functional result, including at the level of the hand, that was poss ible in view of the initial lesions and the intraoperative findings. Theref ore, the treatment strategy included not only nerve repair with grafting (1 24 grafts) or nerve transfer (twenty-seven transfers) but also palliative p rocedures, the latter of which sometimes were performed several years later , Sixty-three patients were evaluated by an independent observer at least thr ee years postoperatively, The results associated with each type of lesion a nd each type of nerve repair were assessed according to the function of the muscles that were innervated by the recipient nerve. Six patients had a ne urolysis only. The remaining fifty-seven patients had grafts or nerve trans fers to repair the biceps, Thirty-six of the fifty-seven received a rating of 3+ or more (meaning that the patient was able to flex the elbow repeated ly); the remaining twenty-one received a rating of 3 or less (meaning that the patient was able to flex the elbow only once or not at all), which we c onsidered unsatisfactory. The function of the triceps recovered after eleve n of thirty-one procedures that were performed to restore that nerve; that of the extensor carpi radialis, after five of thirty-one procedures; that o f the flexor carpi radialis, after six of thirty-one procedures; and that o f the flexor digitorum, after four of thirty-one procedures. A statistical analysis revealed that an operative delay of less than six mo nths was a significant factor,vith respect to recovery of the function of t he biceps (p = 0.003), The thirty-nine grafts that were sutured onto the la teral or posterior cord produced better results than did the thirty-six tha t were sutured onto the distal branches (the musculocutaneous and radial ne rves); however, with the numbers available, this difference was not found t o be significant (p = 0.08). Eleven patients had a successful result (a rating of 3+ or more) and eight, a fair or poor result, with respect to recovery of biceps function after t ransfer of the spinal accessory nerve to the musculocutaneous nerve. Overal l, twenty-nine patients had relief of pain postoperatively, Sixteen patient s Lad grade-3 pain preoperatively compared with only three after the operat ion. According to a self-rating scale, twenty-five patients were satisfied with the overall result, sixteen were fairly satisfied, and twenty-two were dissatisfied.