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Reoperative Brachial Plexus Surgery

  • Douglas M. Sammer
  • Susan E. MackinnonEmail author
Chapter

Abstract

This chapter provides a very nice outline and summary of options in treating the patient who has experienced no recovery or only partial recovery after a brachial plexus injury. These options are broken down into those that help hand function, elbow function, and shoulder function. Common reoperative procedures to improve the function of a patient with a brachial plexus injury that has not healed from the initial procedures include tendon transfers, joint fusions, and, in some circumstances, sensory nerve transfers in order to maximize the patient’s ability to gain some function with the extremity. In extreme cases, where a patient is having severe chronic pain, as well as in some other unique situations, the option of amputation can be entertained. Expertise in brachial plexus surgery is difficult for the individual hand surgeon to gain unless he or she is at a major referral center. However, fusions and tendon transfers may be within the typical hand and upper extremity surgeon’s repertoire. This chapter outlines these reconstructive options for this difficult and ­challenging clinical situation.

Keywords

Brachial Plexus Fusion Tendon Transfers 

References

  1. 1.
    Bunnell S. Restoring flexion to the paralytic elbow. J Bone Joint Surg Am. 1951;33-A(3):566–71, passim.Google Scholar
  2. 2.
    Comtet JJ, Herzberg G, Naasan IA. Biomechanical basis of transfers for shoulder paralysis. Hand Clin. 1989;5(1):1–14.PubMedGoogle Scholar
  3. 3.
    Doi K, Muramatsu K, Hottori Y, Watanabe M. Reconstruction of upper extremity function in brachial plexopathy using double free gracilis flaps. Tech Hand Up Extrem Surg. 2000;4(1):34–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Doi K, Sakai K, Ihara K, Abe Y, Kawai S, Kurafuji Y. Reinnervated free muscle transplantation for extremity reconstruction. Plast Reconstr Surg. 1993;91(5):872–83.PubMedGoogle Scholar
  5. 5.
    Elhassan B, Bishop A, Shin A. Trapezius transfer to restore external rotation in a patient with a brachial plexus injury. A case report. J Bone Joint Surg Am. 2009;91(4):939–44.PubMedCrossRefGoogle Scholar
  6. 6.
    Goubier JN, Teboul F. Management of hand palsies in isolated C7 to T1 or C8, T1 root avulsions. Tech Hand Up Extrem Surg. 2008;12(3):156–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Hawkins RJ, Neer 2nd CS. A functional analysis of shoulder fusions. Clin Orthop Relat Res. 1987;223:65–76.PubMedGoogle Scholar
  8. 8.
    Kotwal PP, Mittal R, Malhotra R. Trapezius transfer for deltoid paralysis. J Bone Joint Surg Br. 1998;80(1):114–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Mayer L, Green W. Experiences with the Steindler flexorplasty at the elbow. J Bone Joint Surg Am. 1954;36-A(4):75–89; passim.Google Scholar
  10. 10.
    Monreal R, Paredes L, Diaz H, Leon P. Trapezius transfer to treat flail shoulder after brachial plexus palsy. J Brachial Plex Peripher Nerve Inj. 2007;2:2.PubMedCrossRefGoogle Scholar
  11. 11.
    Narakas AO. Muscle transpositions in the shoulder and upper arm for sequelae of brachial plexus palsy. Clin Neurol Neurosurg. 1993;95 Suppl:S89–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Ray WZ, Kasukurthi R, Yee A, Mackinnon SE. Functional recovery following an end to side neurorrhaphy of the accessory nerve to the suprascapular nerve: case report. Hand (N Y) 2009.Google Scholar
  13. 13.
    Ruhmann O, Schmolke S, Bohnsack M, Flamme C, Wirth CJ. Shoulder arthrodesis: indications, technique, results, and complications. J Shoulder Elbow Surg. 2005;14(1):38–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Saha AK. Surgery of the paralysed and flail shoulder. Acta Orthop Scand. 1967;Suppl 97:5–90.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryUniversity of Texas Southwestern Medical SchoolDallasUSA
  2. 2.Department of SurgeryWashington University School of MedicineSt. LouisUSA

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