Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis

Thus far, devastating injuries of the adult brachial plexus have had a poor prognosis. This article presents the possible outcomes of aggressive micro surgical reconstruction in the largest series of patients in North America to date. It should change the pessimistic outlook that has surrounded these lesions. In this study, the outcomes of surgery were analyzed in relation to the typ e and level of injury, the age of the patient, and the denervation time; st ronger donors for neurotization in relation to the various targets were del ineated. The results were analyzed in 204 patients with adequate follow-up from a total of 263 patients who were operated on between 1978 and 1996. Th e mean age of the patients was 25.9 years, and the injuries were caused by high-velocity motor accidents involving avulsion in 55 percent of the patie nts. Nerve reconstruction included 577 nerve repairs (140 direct neurotizat ions and 437 cases of nerve grafting). Microneurolysis was performed in 89 cases. Vascularized nerve grafts were used in 120 repairs. Muscle transfers (29 pedicled and 78 free) were used to enhance function. The results were good or excellent in 75 percent of suprascapular nerve reconstructions, 40 percent of deltoid reconstructions, 48 percent of biceps reconstructions, 3 0 percent of triceps reconstructions, 35 percent of finger-flexion reconstr uctions, and 15 percent of finger-extension reconstructions. The majority o f the patients had protective sensation and pain relief postoperatively.