Debora Garozzo, Elisabetta Basso, Roberto Gasparotti, Piero Di Pasquale, Fabrizio Lucchin and Stefano Ferraresi
Background: Brachial plexus palsies are often devastating injuries leading to severe functional impairment of the
upper limb. Their surgical management has greatly changed in the last 30 years and it is still evolving but nowadays
the key role of surgery in reversing the destiny of many of these patients is clearly recognized.The Authors are
presenting their guidelines of management and repair strategy in the surgical treatment of these injuries.
Method: 578 post-traumatic brachial plexus injuries in adults were operated in 23 years: 428 supraclavicular and
150 infraclavicular lesions. A retrospective analysis of the surgical strategies applied in supraclavicular injuries and
their outcome has been performed. A follow up of at least two years is available in 303 patients.
Results: In upper brachial plexus injuries, surgery restored good shoulder and elbow function in more than 90%
of cases, regardless the presence of avulsions. Total palsies still retaining some hand function (due to one lower root
in continuity with the spine) also received remarkable benefit in about 60% of cases. Shoulder and elbow function
were recovered in 40% of complete injuries with multiple avulsions.
Conclusions: Advances in preoperative imaging techniques, electrodiagnostic studies and reconstructive
surgery have made possible to provide remarkable functional improvement in brachial plexus injuries. Early diagnostic
assessment, correct timing of surgery and appropriate rehabilitation are crucial to obtain a rewarding outcome.