Injury to the brachial plexus during Putti-Platt and Bristow procedures. A report of eight cases.

Eight patients with documented recurrent anterior dislocation of the shoulder sustained iatrogenic brachial plexus injuries during either Putti-Platt or Bristow procedures. Two patients also sustained axillary artery injuries. There were six males and two females. Postoperatively, complete paralysis of the musculocutaneous nerve was noted in six cases and incomplete paralysis in one case. Two patients had complete axillary nerve palsies. There were two cases of partial paralysis of the radial, median, and ulnar nerves, respectively. Seven of the patients underwent brachial plexus exploration an average of 16 weeks following their initial operation (range, 4 to 40). Suture material was removed from around or within two musculocutaneous nerves and one ulnar, one median, and one axillary nerve. Two lacerated musculocutaneous nerves were amenable to delayed primary repair. Two musculocutaneous, one median and one axillary nerve required grafting. Injury to the brachial plexus was associated with inadequate knowledge of regional anatomy, blind clamping of axillary artery lacerations, use of axillary incisions which limited exposure, and failure to identify the musculocutaneous nerve during Bristow procedures. If a brachial plexus injury occurs during a Putti-Platt or a Bristow procedure and the lesion does not rapidly, progressively, and completely recover, the brachial plexus should be explored since there is a high likelihood of structural neurologic injury.