Introduction: Repair of Brachial plexus injury is a neglected art in developing countries like Nepal. We discuss here various case scenarios managed at our center and the challenges involved.
Methods: Patients with brachial plexus injury attending NINAS, Bansbari from July 2010 till March 2011, were included in this study. Injury was classified as complete brachial plexus injury (pre-ganglionic or post- ganglionic), partial brachial plexus injury and peripheral nerve injury. Different neurotization and repair techniques were used depending on the situation. Outcome in form of improvement in function and relief of pain were evaluated.
Results: 83 patients with brachial plexus injury were evaluated. Majority of them were too late to be offered any treatment. 20% patients had neuropraxia and were managed conservatively. 25 patients were operated, all of whom were male. 10 were complete preganglionic brachial plexus injury and underwent extra-plexal neurotization procedures. 10 were partial brachial plexus injury and had intra/ extra-plexal neurotization procedures. Neurolysis were done as required. 5 cases of peripheral nerve injury were managed with direct repair in 2 and neurolysis in 3 patients. Good recovery of function (MRC>3) was seen in 55% patients. Patients who underwent early surgical intervention had good recovery in terms of recovery of targeted function and relief of pain.
Conclusions: Due to lack of awareness and socioeconomic reasons, majority of Nepalese people approach very late for surgical options. Benefit of the brachial plexus repair depends upon factors like type of injury, adequate timing of intervention, surgical technique and post operative follow up. We had good outcome in our patients who came early and continued on follow up.
Patient Care: 1. Disseminate information related to brachial plexus injury in Nepal
2. Discuss different options available for reanimation
3. Identify factors related to outcome
Learning Objectives: 1. Difficulties in managing brachial plexus injury in Nepal
2. Different options available for surgical repair
3. Factors related to outcome of surgical repair