Treatment of radiation-induced brachial plexopathy with omentoplasty

Radiation-induced brachial plexus neuropathy (RIBPN) is a rare and delayed non-traumatic injury to the brachial plexus, which occurs following radiation therapy to the chest wall, neck, and/or axilla in previously treated patients with cancer. The incidence of RIBPN is more common in patients treated for carcinoma of the breast and Hodgkin lymphoma. With the improvement in radiation techniques, the incidence of injury to the brachial plexus following radiotherapy has dramatically reduced. The currently reported incidence is 1.2% in women irradiated for breast cancer. The progression of symptoms is gradual in about two-thirds of cases; the patients may initially present with paresthesia followed by pain, and later progress to motor weakness in the affected limb. We present the case of a 68-year-old female patient with breast cancer submitted to surgery, chemotherapy, and radiotherapy in the year 2000. Eighteen years later, she developed symptoms and signs compatible with RIBPN and was successfully submitted to omentoplasty for pain control. Omentoplasty is an alternative treatment for RIBPN refractory to conservative treatment, which seems to be effective in improving neuropathic pain. However, postoperative worsening of the motor strength is a real possibility, and all candidates for this type of surgery must be informed about the risk of this complication.

Transferencia de la cabeza larga del tríceps para la flexión del codo en secuela de lesiones del plexo braquial / Transfer of the long head of triceps for elbow flexion in braquial plexus sequelae

Resumen: La anatomía neurovascular independiente de la cabeza larga del tríceps braquial y su idoneidad como un colgajo muscular libre han sido ampliamente estudiadas. En cambio, la trasposición de esta porción del tríceps para mejorar la flexión de codo ha sido descrita pocas veces. Se describen en este artículo dos casos de secuela de lesión del plexo braquial, en los que se realizó trasposición únicamente de la cabeza larga del tríceps. Se logró mejorar la flexión del codo y se conservó la extensión del mismo.

Abstract: The independent neurovascular anatomy of the long head of the triceps brachii and its suitability as a free muscle transfer have been extensively studied. Instead muscle transposition of the long head of the triceps brachii to enhance elbow flexion has been rarely described. We describe in this paper two cases of injury of brachial plexus sequel in which transposition was performed only on the long head of the triceps. The elbow flexion was improved, the extension was preserved.

Neonatal brachial plexus palsy: a permanent challenge / Paralisia do plexo braquial neonatal: um desafio permanente

Neonatal brachial plexus palsy (NBPP) has an incidence of 1.5 cases per 1000 live births and it has not declined despite recent advances in obstetrics. Most patients will recover spontaneously, but some will remain severely handicapped. Rehabilitation is important in most cases and brachial plexus surgery can improve the functional outcome of selected patients. This review highlights the current management of infants with NBPP, including conservative and operative approaches.

A paralisia neonatal do plexo braquial (PNPB) tem uma incidência de 1,5 casos por 1000 nascidos vivos e não tem diminuído a despeito dos recentes avanços em obstetrícia. A maioria dos pacientes recupera-se espontaneamente, mas alguns permanecerão com sequelas graves. A reabilitação é importante na maioria dos casos e a cirurgia do plexo braquial pode melhorar o resultado funcional em pacientes selecionados. Esta revisão destaca o manejo atual de lactentes com PNPB, incluindo as terapêuticas conservadora e cirúrgica.