Semin Plast Surg 2004; 18(4): 359-375
DOI: 10.1055/s-2004-837262
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Treatment of Obstetrical Brachial Plexus Paralysis: The Norfolk Experience

Julia K. Terzis1 , 2 , Konstantinos Papakonstantinou3
  • 1Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Virginia
  • 2Microsurgery Program, Eastern Virginia Medical School, Norfolk, Virginia
  • 3Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada
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Publication History

Publication Date:
06 December 2004 (online)


In this article we present the outcomes of primary nerve reconstruction and results of secondary procedures performed to restore or enhance the function of the upper extremity. Ninety-nine patients were operated between 1978 and 2000; the results are analyzed for 84 patients with adequate follow-up. Seventy-five patients underwent 77 primary brachial plexus reconstructions and 24 patients underwent only secondary procedures. Nerve reconstruction included microneurolysis, direct end-to-end and direct end-to-side neurotizations, indirect neurotizations with interposition nerve grafting, and direct nerve-to-muscle neurotizations. Muscle (n = 135 pedicled and 48 free) and tendon (n = 80) transfers were used to enhance function. The results were analyzed in relation to the type of the injury (Erb's versus global paralysis) and the denervation time. The results of reconstruction showed improvement in all muscles tested at a statistically significant level (p < 0.001). The results were good and excellent for 84.87% of biceps, 73.55% of supraspinatus, 71% of deltoid, and 67.8% of triceps restoration. The Mallet scores and the Gilbert-Raimondi scores improved after reconstruction in all patients at a statistically significant level. The outcomes in general were better if the number of avulsed roots was fewer. The denervation time (DT) affected primarily the outcome of the hand function. Patients with DT less than 3 months underwent less surgeries (1.3 surgeries per patient) to complete the reconstruction than patients with DT between 3 and 6 months (3.1 surgeries per patient).


Julia K Terzis, M.D. , Ph.D. 

Microsurgical Research Center, Eastern Virginia Medical School

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Norfolk, VA 23501