Obstetric Brachial Plexus Injuries Following Breech Delivery: An Adverse Experience in The Netherlands

ABSTRACT

Obstetric brachial palsy following breech delivery is a typical group: upper lesions predominating with a great number of upper root avulsions and phrenic nerve lesions. In some cases spontaneous nerve recovery is insufficient and further treatment is considered in the first months of the infant's life. The results of surgical treatment of 61 cases of upper brachial plexus lesions after vaginal breech delivery who did not recover sufficiently are reported. In this group the following nerve transfers were applied: 51 accessory, 28 medial pectoral, 2 hypoglossal nerve transfers, and in 2 cases transfer of intercostals; in some cases the transfers were part of an extended brachial plexus reconstruction. Generally, the results of both primary and possibly secondary operations in this series were rewarding: 53% good and 20% fair. In both these groups most patients are able to position and use their more or less normal hand such that they can function normally, without serious impairment according to the international classification.

KEYWORDS

Brachial plexus palsy - obstetric - surgical treatment - nerve transfers - nerve reconstructions - breech delivery

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