Results and current approach for Brachial Plexus reconstruction

Brachial plexus lesions are a tragic condition that usually affects young adults, with significant socioeconomic implications. Only four decades ago, brachial plexus surgery still was approached with considerable pessimism. As recently as the 1996 International Society for Orthopaedic Surgery and Traumatology (SICOT) in Paris, it was concluded that surgical repair of these lesions was almost impossible and, even when performed, did not guarantee a useful result [1]. However, the ongoing increase in the number of civilian brachial plexus lesions due to motorcycle accidents has, without a doubt, promoted interest in this field, and recent years have witnessed tremendous progress in surgical techniques for brachial plexus repair. At our institution, between January 2002 and December 2008, 335 patients suffering from supraclavicular brachial plexus palsy underwent surgical repair. In the present report, we review our results and current approach to treatment. Written informed consent were obtained from patients for publication of clinical cases and accompanying images. In advance of any data collection, the protocol of the present study was approved by the local ethics committee. All patients provided their written informed consent prior to their participation, in accordance with the Declaration of Helsinki guiding biomedical research involving human subjects.In half of our patients, electrophysiological studies were available preoperatively. In 102 patients, magnetic resonance imaging (MRI) of the brachial plexus, including the spinal cord, was obtained, whereas computed tomomyelography (CT myelography) was performed in all cases. The clinical diagnosis of root involvement was correct in 85% of our patients. Extremely reliable tests or signs were a supraclavicular Tinel's sign to indicate a graft-able root, and a Horner's sign to indicate lower root avulsion [2]. Electrophysiological studies did not contribute, in any way, to identifying indications for surgery or to s