Brachial Plexus Injuries in Adults: Management and Repair Strategies in our Experience. Results from the Analysis of 428 Supraclavicular Palsies

Background: Brachial plexus palsies are often devastating injuries leading to severe functional impairment of the upper limb. Their surgical management has greatly changed in the last 30 years and it is still evolving but nowadays the key role of surgery in reversing the destiny of many of these patients is clearly recognized.The Authors are presenting their guidelines of management and repair strategy in the surgical treatment of these injuries. Method: 578 post-traumatic brachial plexus injuries in adults were operated in 23 years: 428 supraclavicular and 150 infraclavicular lesions. A retrospective analysis of the surgical strategies applied in supraclavicular injuries and their outcome has been performed. A follow up of at least two years is available in 303 patients. Results: In upper brachial plexus injuries, surgery restored good shoulder and elbow function in more than 90% of cases, regardless the presence of avulsions. Total palsies still retaining some hand function (due to one lower root in continuity with the spine) also received remarkable benefit in about 60% of cases. Shoulder and elbow function were recovered in 40% of complete injuries with multiple avulsions. Conclusions: Advances in preoperative imaging techniques, electrodiagnostic studies and reconstructive surgery have made possible to provide remarkable functional improvement in brachial plexus injuries. Early diagnostic assessment, correct timing of surgery and appropriate rehabilitation are crucial to obtain a rewarding outcome.