Neurotization in microsurgical repair of obstetric brachial plexus palsy: Surgical outcome of different techniques.

BACKGROUND

In the treatment of obstetric brachial plexus palsy (OBPP), neurotization, or nerve transfer, has become a crucial microsurgical procedure, especially when nerve roots are avulsed or non-functional. To reinnervate a denervated target and restore motor function, a functional donor neuron must be redirected. The objective of the study is to assess the outcomes of various neurotization approaches in individuals with brachial plexus injuries sustained during pregnancy.

METHODS

Thirty patients with OBPP who received microsurgical treatment using various brachial plexus neurotization procedures at Menoufia University Hospital between January 2018 and January 2024, with postoperative follow-up for at least 18 months, were included in this nonrandomized prospective study. Intraplexal neurotization used the existing healthy root stumps, which were ruptured for reconstruction by joining them with the distal target trunks, cords, or nerves using nerve grafts. The extraplexal neurotization was done by extraplexal nerves, such as the spinal accessory nerve, intercostal nerves, and/or contralateral C7 root.

RESULTS

The outcome of different joint movements showed improvement of the shoulder (good: n = 25, 83.33%) better than in the elbow (good: n = 20, 66.67%), while the finger movement showed the least improvement (good: n = 17, 56.67%). The suprascapular nerve neurotization outcome by spinal accessory nerve showed n = 28, 94.4% good outcome and n = 2, 5.6% fair outcome which were better than outcome by C5 root neurotization (n = 20, 66.7% good and n = 10, 33.3% fair).

CONCLUSION

When a nerve source is present in the damaged plexus, intraplexal neurotization is utilized; if not, extraplexal nerve sources may be utilized. Results from spinal accessory nerve neurotization of the suprascapular nerve are superior to those from intraplexal neurotization.