Functional Outcomes of Nerve Reconstruction in Severe Obstetric Brachial Plexus Palsy

Background Microsurgical era has brought a renewed interest in the management of birth-related brachial plexus palsy. There is a general agreement that severe obstetric palsy should be treated by an early nerve reconstruction. Patients and Methods This report is an experience in the primary nerve reconstruction in 32 cases of obstetric brachial plexus lesions in the age group 3.5 to 23 months. Parietal injuries were most commonly associated with truncal neuromas. Conducting neuromas were subjected to neurolysis, whereas nonconducting neuromas were treated by resection and nerve grafting. Restoration of hand functions was a priority in total lesions. In total palsy, a viable root stump if available was connected with nerve grafts to the distal nerve, primarily targeted toward the hand, and nerve transfers were performed for shoulder and elbow. Results A total of 20 patients had C5, C6 injuries and 5 had an associated C7 injury. Seven patients presented with total palsy. The follow-up period ranged from 14 to 42 months. Patients with partial palsy and early surgical intervention produced good functional results in relation to the elbow and shoulder. Recovery in hand function in total palsy was satisfactory to poor. Conclusion Microsurgical reconstruction is indicated for those infants who fail to recover antigravity biceps flexion by 4 to 6 months of age. An early intervention by 3 months is desirable in total palsy.