OUTCOME OF SURGICALLY TREATED BIRTH-RELATED BRACHIAL-PLEXUS INJURIES IN 20 CASES

Birth-related brachial plexus injury occurs in 0.19-2.5 per 1,000 live births, of which 70-92% improve with conservative management. With th e advent of microsurgical techniques, patients who fail expectant trea tment may benefit from brachial plexus exploration and reconstruction. From 1991 to 1996, 87 patients were referred to the multidisciplinary brachial plexus clinic at St. Louis Children's Hospital. Twenty patie nts were selected for surgical management. The average age at surgery was 10.5 months (range 3-35, median = 8), with an average follow-up of 23.9 months (range 7-45, median = 24). Two patients were lost to foll ow-up. Surgical procedures included neurolysis (n = 8), neurotization (n = 2), nerve grafting (n = 5), and a combination (n = 3) of the abov e. Two patients underwent exploration without repair. Intercostal nerv es, pectoral nerves, and C4 roots were used for neurotizations, and th e sural nerve was used for nerve grafting. Results from 18 patients we re available for follow-up review. Fifteen patients (83% demonstrated clinical improvement postoperatively. Of the 3 patients without improv ement, 2 underwent exploration without repair, and one underwent neuro lysis of the axillary nerve. Of patients undergoing reconstruction, 93 % had improved strength postoperatively. No subjects had worsening neu rologic status, and there were no complications. These results suggest that surgery for birth-related brachial plexus injury may show favora ble outcomes if patients are selected appropriately. Patients undergoi ng neurolysis and nerve grafting had more favorable outcomes than thos e undergoing neurotization.