1352. Improving results in traumatic brachial plexus injury in a developing country

Award: Third Place Peripheral Nerve Eposter Award

Authors: Amit Thapa, MBBS, MS, MCh (Kathmandu, Nepal)

Introduction:

Repair of Brachial plexus injury (BPI) is a neglected art in developing countries. Despite challenges we have been able to surgically manage these difficult cases. We discuss here various case scenarios and how to overcome challenges, unique in developing countries.

Methods:

Cases with brachial plexus injury attending our OPD were included in this study. Individual cases are discussed particularly in reference to management of complete brachial plexus injury, partial brachial plexus injury and peripheral nerve injury. Different neurotisation and repair techniques were used depending on the situations. Outcome in form of improvement in function and relief of pain were evaluated.

Results:

During the last 7 year (July 2011 to July 2018), 175 patients with brachial plexus injury were evaluated in our outpatient OPD with majority too late to be offered a constructive treatment. 20% patients had neuropraxia and were managed conservatively. 90 surgically managed patients maintained on follow up. 41 were complete brachial plexus injury and underwent extraplexal neurotisation procedures. 36 were partial brachial plexus injury and had  intraplexal neurotisation procedures including SETS (supercharged end to side anastomosis). Neurolysis were done as required. 13 case of peripheral nerve injury was managed with direct repair and neurolysis. Almost all patients with neuropraxia had good recovery in follow up. Patients who underwent surgical intervention had good recovery in terms of recovery recovery of function and relief of pain.

Conclusion:

Due to lack of awareness and socioeconomic reasons, majority of nepalese people approach very late for surgical options. Benefit of the brachial plexus repair depends upon factors like type of injury, timing of intervention, surgical technique and post operative follow up. We had good outcome in our patients who came early and continued on follow up. Standardized protocols and newer tested options provide better alternatives.