EARLY MICROSURGICAL TREATMENT OF OBSTETRI CAL BRACHIAL-PLEXUS LESIONS- PATIENT SELECTION AND RESULTS

A review of the literature reveals that with conventional treatment al one or in combination with secondary muscle/tendon transfer, about 4-4 3 % of cases show incomplete recovery with severe functional and/or ae sthetic impairment (group III). If these patients undergo early micros urgical brachial plexus revision, regeneration without significant fun ctional and/or aesthetic impairment (shift from group III to group II) can be achieved in 80-90 % of cases. Moreover, microsurgical reconstr uction of the brachial plexus increases the possibilities of secondary muscle/tendon transfers. Therefore, provided patient selection is goo d, severe obstetrical brachial plexus injuries should be scheduled for early microsurgical revision. There is no need to wait for a frustrat ing spontaneous recovery. Our concept is based on our experience with more than 1100 patients presenting with brachial plexus lesions betwee n 1981 and 1996 and treated in our institution. There were 217 obstetr ical brachial plexus lesions, 133 of which were treated conservatively . In 84 cases operative treatment was necessary. Fifty-one cases under went early revision of the brachial plexus, and secondary tendon trans fer was done in 33 patients.