1341. Surgical Decision Making in Brachial Plexus Birth Injuries

Authors: Christopher A. Gegg, MD, FAANS, FACS; Andrea Scherer, MD (Orlando, FL)

Introduction: Brachial plexus birth injuries range from transient to profound permanent neurologic impairment. Decision making can be divided into 2 parameters; first a decision for surgical correction and second, what type of operation is best for the patient. We present 22 patients with brachial plexus birth injuries that had a total of 24 operations (brachial plexus and/or peripheral nerve transfers) and the guided decisions. Methods: Patients with partial injuries were given consideration for distal nerve transfers (ex. Oberlin), while patients with more complete trunk injuries were best managed with a brachial plexus operation. Decisions were made by 3 months of age when possible. Ages at time of operation ranged from 4 months to 10 months over a 17 month time period. Two partial trunk injury patients had distal nerve transfers alone; 16 patients with isolated complete upper trunk injuries had brachial plexus repairs with grafting and accessory to supra scapular nerve transfers, 4 of these also had distal nerve transfers and 2 of these transfers were at a second stage for biceps recovery. The 4 patients with the worst injuries ( ex. flail arms) required more extensive repair. Results: All patients were graded with the Mallet scale; the patients that had distal nerve transfers improved the fastest, while the patients with upper trunk repairs showed improvement by 8 months and one by 6 months. The patients with the more severe injuries were the slowest to improve; 1 had near full functional recovery by 14 months. Conclusions: Decision making in brachial plexus birth injury patients is best separated into 2 parameters. The necessity of an operation based on following the physical exam closely and second, what type of operation is best. The second decision is best made during the operation. We thus consent for all possibilities and results appear favorable.