Microsurgical treatment of the brachial plexus cord terminal branch injuries with concomitant major vessel injuries / 中华显微外科杂志

ABSTRACT

Objective To explore the clinical outcomes of surgical treatment of brachial plexus cord terminal branch injuries combined with rupture of major upper limb vessels and discuss the optimal timing and surgical procedures.Methods From June,2007 to June,2012,there were 9 cases of the brachial plexus cord terminal branch injuries with concomitant major vessel injuries.Two cases had combined subclvian arterial injuries,1 had combined the first part of axillary arterial injuries,1 had the third part of axillary arterial injuries and 5 had brachial arterial injuries.Depending on the region,type and severity of the injuries,nerve and vascular reconstruction was done simultaneously in the acute phase of the injuries in 3 cases and in the subacute phase in another 2 cases.In 4 cases,the vessels were repaired acutely while nerve reconstruction was carried out in a second stage.Results Nine patients were followed-up from 50 to 78 months with an average of 61.8 months.There was no necrosis of the affected limbs.CTA showed that all the artificial blood vessels were patent after surgery.Nerve functions recovered to various extents.The muscle strength was recovered to grade 3 or better in 9 patients,except 3 cases in which the intrinsic muscles were control by ulnar nerve.(S) or better sensory recovery was seen in all repaired nerve area in 4 patients,and S3 or better sensory recovery was seen in part of the repaired nerve area in 5 patients.Conclusion The brachial plexus cord terminal branch injury is rare and complicated,which request a reasonable treatment program.Under the guideline of saving life first,primary and simultaneous reconstruction of both the nerves and vessels should be attempted by microsurgical treatment whenever possible for improving the success rate of surgery and a better functional recovery.