Management strategy in post traumatic brachial plexus injuries

Background: Traumatic brachial plexus injury is a devastating condition resulting mainly from motor cycle accidents and primarily affecting the young adults. In the past there was a pessimistic attitude in the management of these injuries. However in last two decades with the introduction of microsurgical techniques and advances in imaging modalities, these injuries are being explored and repaired early with satisfactory to good functional out comes. Methods: Neurolysis, nerve repair, nerve grafting, nerve transfer, pedicle muscle transfer and functioning free-muscle transfer are the main surgical procedures in the management of brachial plexus injury. In the management of these injuries an immediate intervention is considered in penetrating trauma. All other common high velocity traction injuries are initially observed for a spontaneous recovery. If there are no signs of recovery by three months, surgery is indicated, as further delay will affect the ultimate results. In global brachial plexus palsy with all root avulsions, intervention is even earlier, as chances of spontaneous recovery are practically nil. Results: Good results are expected with early intervention in upper plexal lesions. Results are favorable with short nerve grafts, distal nerve transfers, and intraplexal neurotization. The aim in global brachial plexus palsy is to restore the elbow flexion and provide a stable shoulder. Restoration of a fully functional and sensate hand is still far from being a reality. Conclusion: The management of brachial plexus injury remains a challenging problem. Functional results have considerably improved in the past two decades with the incorporation of microsurgical techniques in nerve surgery, and advancements in anesthesia. Following microsurgical reconstruction many of these patients are expected to return to their original work and amputation is no longer considered a treatment option. Copyright (C) 2012, Neurotrauma Society of India. All rights reserved.