Multiple neurotization in Preganglionic Whole Arm Type of Brachial plexus injury

Kim, Sang Soo; Kim, Young Jin; Kim, Hak Sun

Abstract

In the whole arm type of brachial plexus injury, the nerve grafting method give the best result. As it is impossible, however to operate the preganglionic whole arm type by interfascicular nerve graft, the treatment of this type of injury is difficult. In this lesion, neurotization may be the only useful method. To evaluate it's efficacy, 38 cases of multiple neurotization have been reviewed. The follow up period was on average 45 months(24 months to 76 months). The results are as follows: 1. Motor or sensory improvement of good or better results was observed in 27 nerves(29%) and that of better-than-fair results in 54 nerves(57%). 2. The best results were obtained in patients less than thirty year old and in the patients where the operation was performed within the first six months after injury(19 cases, 42%). 3. The use of spinal accessory, phrenic, intercostal and supraclavicular nerves, as a source of neurotization produced similar results. Phrenic nerve neurotization was performed without any significant respiratory difficulty. 4. The results of neurotization were analysed by Kim's method. Functional recovery of the upper extremity showed relatively poor results. 5. Out of the 25 patients who had developed a painful syndrome before neurotization, 19 cases(60%) showed improvement of the symptom. Multiple neurotization in preganglionic whole arm type of brachial plexus injury is of a little value in improving upper extremity function. Nerve neurotization can not always make a paralysed upper limb useful, because it is impossible to control the digits and intrinsic muscles in the hand and to restorate fine sensation by it. Nevertheless, functional recovery of the paralyzed upper limb, compared with no previous muscle contraction, encourages patients who have suffered serious brachial plexus injuries to start an active their life again.