Purpose: Today easy, quick and effective examination of shape and structure of peripheral nerves in posttraumatic period is a difficult task for traumatologists and neurosurgeons. The progressive refinement of broadband transducers with frequencies higher than 10MHz and improved near-field resolution has enhanced the potential of sonography to depict changes in the nerve's shape and echotexture. This investigation was designed to analyze if high-resolution ultrasonography can be helpful in evaluation of brachial plexus nerves posttraumatic changes and in assessment of results of performed plastic surgery. Up to date a few data on this topic can be found in the literature.
Methods and Materials: The diagnostic possibilities of ultrasonography were analyzed in 22 patients one month after brachial plexus branches injury. 19 individuals had combined open injury of tendons, muscles and nerves (all of them underwent plastic surgery shortly after trauma), 3– blunt trauma. 28 nerves were studied: 8– directly plexus brachialis, 15– nervus medianus, 3– nervus ulnaris, 2– nervus radialis. Injury of plexus brachialis included total supraclavicular injury of brachial plexus in 2 cases and injury of posterior and interior trunk of brachial plexus in 6 cases. Damaged and contralateral intact arm were examined for comparison.
Results: High-frequency ultrasonography imaging was performed in longitudinal and transverse planes taking into account topographic and anatomic landmarks. The region of interest was determined by localization of injury and presence of scar tissue. In 2 patients results of plastic surgery was unsatisfactory. Diastasis between proximal and distal parts of nerves was detected. In other 17 postoperative patients the diastasis was absent. During longitudinal scanning in these patients it was possible to visualize hypoechoic heterogeneous fusiform structures of different length. During transverse scanning these structures had rounded or oval shape with echodense capsule. In 14 patients nerve's atrophy below the place of injury as decrease in cross-sectional area was revealed.
Conclusions: High-resolution sonography can become a promising approach to evaluation of brachial plexus nerves posttraumatic changes and results of performed plastic surgery.
