Kachramanoglou, C;
Carlstedt, T;
Koltzenburg, M;
Choi, D;
(2017)
Long-term outcome of brachial plexus re-implantation after complete brachial plexus avulsion injury.
World Neurosurg
, 103
pp. 28-36.
10.1016/j.wneu.2017.03.052.
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Abstract
BACKGROUND: Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus re-implantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury. OBJECTIVE: We assessed the functional recovery in 15 patients who have undergone brachial plexus re-implantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing METHODS: We included all patients that underwent brachial plexus re-implantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests. RESULTS: We found that patients who had re-implantation surgery demonstrated an improvement in MRC power in the deltoid, pectoralis and infraspinatous muscles and "global MRC score". Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved re-innervation by EMG criteria was found in infraspinatous, biceps and triceps muscles. There was evidence of ongoing innervation in three patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6 and T1 dermatomes. The best recovery was seen in the C5 dermatome. CONCLUSION: Our results demonstrate a definite but limited improvement in motor and sensory recovery following re-implantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair.
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