Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(01): 029-037
DOI: 10.1055/s-0040-1719196
Original Article

“All in One or (W)hole in One Repair” for Adult Total Brachial Plexus Palsy

V. Purushothaman
1   Department of Plastic and Reconstructive Surgery, Apollo First Med Hospital, Chennai, Tamil Nadu, India
,
K. Vinoth Kumar
1   Department of Plastic and Reconstructive Surgery, Apollo First Med Hospital, Chennai, Tamil Nadu, India
,
Sabari Girish Ambat
1   Department of Plastic and Reconstructive Surgery, Apollo First Med Hospital, Chennai, Tamil Nadu, India
,
R. Venkataswami
1   Department of Plastic and Reconstructive Surgery, Apollo First Med Hospital, Chennai, Tamil Nadu, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Total brachial plexus palsy (TBPP) accounts for nearly 50% of all brachial plexus injuries. Since achieving a good functional hand was almost impossible, the aim was settled to get a good shoulder and elbow function. It was Gu, who popularized the concept of utilizing contralateral C7 (CC7) with vascularized ulnar nerve graft (VUNG) to get some hand function. We have modified it to suit our patients by conducting it as a single-stage procedure, thereby trying to get a functional upper limb.

Methods From 2009 to 2014, we had 20 TBPP patients. We feel nerve reconstruction is always better than any other salvage procedure, including free muscle transfer. We modified Gu's concept and present our concept of total nerve reconstruction as “ALL IN ONE OR (W)HOLE IN ONE REPAIR.”

Results All patients able to move their reconstructed limbs independently or with the help of contralateral limbs. Three patients developed hook grip and one patient was able to incorporate limbs to do bimanual jobs. One important observation is that all the reconstructed limbs regain the bulk, and to a certain extent, the attitude and appearance looks normal, as patients no longer hide it or hang it in a sling.

Conclusion Adult brachial plexus injury itself is a devastating injury affecting young males. By doing this procedure, the affected limb is not dissociated from the rest of the body and rehabilitation can be aimed to get a supportive limb.

Keywords

Contralateral C7 - Superior ulnar collateral artery - Total Brachial Plexus Palsy - Vascularized Ulnar Nerve Graft


Publication History

Article published online:
10 March 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Jain DK, Bhardwaj P, Venkataramani H, Sabapathy SR. An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre. Indian J Plast Surg 2012; 45 (03) 498-503
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Zhang CG, Gu YD. Contralateral C7 nerve transfer - Our experiences over past 25 years. J Brachial Plex Peripher Nerve Inj 2011; 6 (01) 10
    PubMedGoogle Scholar
  • 3 Doi K, Hattori Y, Ikeda K, Dhawan V. Significance of shoulder function in the reconstruction of prehension with double free-muscle transfer after complete paralysis of the brachial plexus. Plast Reconstr Surg 2003; 112 (06) 1596-1603
    CrossrefPubMedGoogle Scholar
  • 4 Yuan-Kun Tu, Chung KC. Surgical procedures for recovery of hand function. In Practical Management of Paediatric and Adult Brachial Plexus Palsies. 1st ed. USA: Elsevier; 2011: 271-300
    Google Scholar
  • 5 Terzis JK, Kostopoulos VK. Vascularized ulnar nerve graft: 151 reconstructions for posttraumatic brachial plexus palsy. Plast Reconstr Surg 2009; 123 (04) 1276-1291
    CrossrefPubMedGoogle Scholar
  • 6 Wang SF, Li PC, Xue YH, Yiu HW, Li YC, Wang HH. Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion. J Bone Joint Surg Am 2013; 95 (09) 821-827, S1–S2
    CrossrefPubMedGoogle Scholar
  • 7 Wang SF, Li PC, Xue YH, Zou JY, Li WJ, Li Y. Direct coaptation of the phrenic nerve with the posterior division of the lower trunk to restore finger and elbow extension function in patients with total brachial plexus injuries. Neurosurgery 2016; 78 (02) 208-215
    CrossrefPubMedGoogle Scholar