Recovery of hand function following nerve grafting and transfer in obstetric brachial plexus lesions.

OBJECT: Infants with obstetric brachial plexus lesions (OBPLs) commonly undergo surgical repair. Outcome data have been documented extensively for shoulder and biceps function, but information on hand function following nerve repair is limited. Hand function is impaired in approximately 15% of patients. The authors present a surgical strategy aimed primarily at restoration of hand function and analyze their methods and outcome to determine specific factors affecting functional recovery.
METHODS: Surgical strategy and outcome data were reviewed for 33 patients who underwent surgery for flail arm during a 10-year period. Nerve repair was performed at a mean age of 4.4 months. In 16 patients, the period of follow up (mean 50 months) was considered sufficiently long for final analysis. Of these 16 patients, 13 (Group 1) had complete discontinuity of the C-7, C-8, and T-1 spinal nerves. In three patients (Group 2), the C-8 and/or T-1 nerve was left in place because of shortage of nerve grafts or limited availability of proximal donor stumps. Postoperatively, a Raimondi hand function grade of 3 or higher was attained by nine of the 13 patients in Group 1 (69%) and one of the three patients in Group 2 (33%).
CONCLUSIONS: Useful hand function was restored in 69% of the patients in the presented series in whom reanimation of the hand could be fully attributed to the surgical reconstruction. The authors conclude that restoration of hand function should be the first goal of nerve repair in infants with a flail arm caused by an OBPL, but that the optimal strategy for different types of lesion remains to be determined.