POSTIRRADIATION LESIONS OF THE BRACHIAL-P LEXUS - RESULTS AND CURRENTINDICATIONS OF SURGICAL-TREATMENT

Postirradiation neuropathy of the brachial plexus is a chronic progres sive disorder initially showing stepwise deterioration. Cardinal sympt oms are sensory (dysaesthesia, paraesthesia, anaesthesia) and/or motor (paresis, paralysis) deficits and pain. Since such symptoms and signs may also be caused by tumour growth, pre-and intraoperative diagnosis must check neoplasia. Any treatment is only palliative. The aim is to slow down progression and to afford relief from pain as long as possi ble. Motor deficits are irreversible, except proximal muscle movements , especially in the elderly. Non operative treatment is the basis for therapy in every patient. Because of high rates of severe complication s surgical revision of the brachial plexus without additional adjacent soft tissue defect is only rarely indicated. External neurolysis of t he brachial plexus is more commonly performed, using a myocutaneous lo cal or free flap, if the nerve structures have already been laid open in the region of the operation after removal of the tissue that had be en damaged by irradiation.