RECONSTRUCTIVE SURGERIES
Brachial Plexus Surgery
When Should This Surgery Be Avoided?
When is This Surgery Recommended?
Preoperative Management
Surgical Technique
Wound Management
Postoperative Care
Complications
Outcomes and Prognosis
Psychological Support
Multidisciplinary Collaboration
Advances in Surgery
About The Treatment
Brachial plexus injury is a devastating condition resulting from motorcycle or auto accidents, falls, lacerations or other injuries. Brachial plexus surgery is performed by plastic surgeons to repair injuries to the brachial plexus, a network of nerves that control muscles and sensation in the shoulder, arm, and hand. This type of surgery is highly specialized and aims to restore function and reduce pain.
Types of Brachial Plexus Injuries
Avulsion:
Nerve root is torn from the spinal cord.
Rupture:
Nerve is torn but not at the spinal cord attachment.
Neuroma:
Formation of scar tissue around the healing nerve.
Neurapraxia (Stretch Injury):
Nerve is damaged but not torn.
Diagnostic Evaluation
Clinical Examination:
Comprehensive assessment of motor and sensory function in the affected limb.
Imaging Studies:
MRI:
Detailed images of the nerve roots and surrounding soft tissue.
CT Myelography:
Enhanced imaging of the spinal canal and nerve roots.
Electrophysiological Studies:
EMG (Electromyography):
Evaluates the electrical activity of muscles.
Nerve Conduction Studies:
Measures the speed and strength of electrical signals in the nerves.
Surgical Options
Nerve Repair
Direct Nerve Repair (Neurorrhaphy):
End-to-end suturing of the severed nerve ends.
Indicated for:
Clean cuts with minimal tension on the repair site.
Nerve Grafting
Interpositional Grafting:
Use of autologous nerve grafts (e.g., sural nerve) to bridge the gap between nerve ends.
Indicated for:
Nerve gaps where direct repair is not feasible.
Nerve Transfers (Neurotization)
Use of Donor Nerves:
Redirecting healthy, less critical nerves to restore function to the damaged area.
Common Transfers:
Oberlin Transfer: Ulnar nerve fascicles to the musculocutaneous nerve.
Spinal Accessory Nerve to Suprascapular Nerve: To restore shoulder function.
Indicated for:
Proximal injuries where direct repair or grafting is less likely to succeed.
Free Muscle Transfer
Transplantation of a Muscle:
Along with its nerve and blood supply from another part of the body.
Indicated for:
Cases where significant muscle function has been lost and cannot be restored by nerve repair alone.
Neurolysis
Removal of Scar Tissue:
From around the nerve to improve function.
Indicated for:
Neuroma or compression injuries.
Nerve Transfers (Neurotization)
Use of Donor Nerves:
Redirecting healthy, less critical nerves to restore function to the damaged area.
Common Transfers:
Oberlin Transfer: Ulnar nerve fascicles to the musculocutaneous nerve.
Spinal Accessory Nerve to Suprascapular Nerve: To restore shoulder function.
Indicated for:
Proximal injuries where direct repair or grafting is less likely to succeed.
Free Muscle Transfer
Transplantation of a Muscle:
Along with its nerve and blood supply from another part of the body.
Indicated for:
Cases where significant muscle function has been lost and cannot be restored by nerve repair alone.
Neurolysis
Removal of Scar Tissue:
From around the nerve to improve function.
Indicated for:
Neuroma or compression injuries.
Post-Operative Care and Rehabilitation
Immobilization
Initial Period: To protect the surgical site and allow for initial healing (typically 3-6 weeks).
Physical Therapy
Early Mobilization:
Gentle range of motion exercises to prevent stiffness.
Strengthening Exercises:
To rebuild muscle strength as nerve function returns.
Occupational Therapy
Functional Training:
To help patients regain the ability to perform daily activities.
Splinting and Bracing:
To support weak muscles and protect the affected area.
Pain Management
Medications:
For controlling post-surgical pain.
Alternative Therapies:
Such as nerve blocks or electrical stimulation in some cases.
Monitoring and Follow-Up
Regular Assessments:
To monitor nerve regeneration and functional recovery.
Electrophysiological Testing:
To assess progress and guide therapy.
Prognosis and Outcomes
Recovery Timeline:
Nerve regeneration is slow, typically around 1 mm per day. Full recovery can take months to years.
Functional Outcomes:
Depend on the severity of the injury, the timeliness of surgical intervention, and adherence to rehabilitation protocols.
Potential Complications:
Include infection, persistent pain, or incomplete functional recovery.
Advances and Innovations
Tissue Engineering:
Research into artificial nerve grafts and nerve conduits.
Stem Cell Therapy:
Potential to enhance nerve regeneration.
Robotic-Assisted Surgery:
Improved precision in surgical procedures.