Acute repair of traumatic pan-brachial plexus injury: technical considerations and approaches

Neurosurg Focus. 2018 Jan;44(VideoSuppl1):V4. doi: 10.3171/2018.1.FocusVid.17569.

Abstract

Particularly challenging after complete brachial plexus avulsion is reestablishing effective hand function, due to limited neurological donors to reanimate the arm. Acute repair of avulsion injuries may enable reinnervation strategies for achieving hand function. This patient presented with pan-brachial plexus injury. Given its irreparable nature, the authors recommended multistage reconstruction, including contralateral C-7 transfer for hand function, multiple intercostal nerves for shoulder/triceps function, shoulder fusion, and spinal accessory nerve-to-musculocutaneous nerve transfer for elbow flexion. The video demonstrates distal contraction from electrical stimulation of the avulsed roots. Single neurorrhaphy of the contralateral C-7 transfer was performed along with a retrosternocleidomastoid approach. The video can be found here: https://youtu.be/GMPfno8sK0U .

Keywords: C-7 nerve transfer; avulsion; neurorrhaphy; pan–brachial plexus injury; video.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Adult
  • Arm / diagnostic imaging
  • Arm / innervation
  • Arm / surgery
  • Arm Injuries / diagnostic imaging
  • Arm Injuries / surgery*
  • Brachial Plexus / diagnostic imaging
  • Brachial Plexus / injuries*
  • Brachial Plexus / surgery*
  • Hematoma, Subdural / diagnostic imaging
  • Hematoma, Subdural / etiology
  • Hematoma, Subdural / surgery
  • Humans
  • Male
  • Neurosurgical Procedures / methods*
  • Plastic Surgery Procedures / methods*
  • Skiing / injuries*