Hemi-hypoglossal nerve transfer for obstetric brachial plexus palsy: report of 3 cases.

Use of the entire hypoglossal nerve for nerve transfer in obstetric palsy is not recommended because of major donor nerve morbidity in terms of feeding and speech problems. We used a hemi-hypoglossal nerve transfer for biceps reinnervation in obstetric palsy in 3 infants with multiple root avulsions. Two of the 3 infants recovered normal or near-normal elbow flexion. There was no donor nerve morbidity in terms of feeding. Speech was assessed at age 20 to 27 months and was appropriate for age, which indicates that early speech development (speech intelligibility and articulation) were not affected. However, phonological development (expected to develop by age 3 y) and full consonant development (expected to be complete by age 5 y) could not be assessed because all children were younger than age 3 years at final follow-up. Our results confirm the relative safety of using a hemi-hypoglossal nerve transfer in infants. The transfer deserves study in a larger series and with longer follow-up, particularly regarding speech development.

Buttock necrosis and paraplegia after bilateral internal iliac artery embolization for postpartum hemorrhage.

BACKGROUND: Endovascular embolization has become part of the management of postpartum hemorrhage. CASE: We report a case of bilateral extensive gluteal skin and muscle necrosis with concurrent severe lumbosacral plexopathy after bilateral internal iliac artery embolization for postpartum hemorrhage. The ischemic plexopathy was treated conservatively, with a fair outcome. The complex gluteal wound was treated successfully with debridement and skin grafting. CONCLUSION: Pregnancy is known to increase the pelvic collateral blood vessels, and, hence, such a complication in a healthy pregnant woman is extremely rare. The risk of such a severe complication may be minimized by more selective embolization.