Pan brachial plexus palsy is major disability of upper extremity. It is a major plexus injury and often associated with major injury of cervical spine ,fractures or chest trauma. Some cases have associated vascular injury or head injury.
Pan brachial plexus injury is often associated with major trauma the management of life threatening injuries takes precedence and brachial plexus is tackled later on.
Initial surgery is nerve transfer for shoulder and elbow function. Nerve transfer for shoulder is used innervate suprascapular and shoulder muscle.. Spinal accessory is used for suprascapular nerve. It is a pure motor nerve which powers trapezius muscle, and distal portion is used preserving proximal trapezius. For deltoid muscle Phrenic nerve is used via nerve graft. Around 10 cm nerve graft is used to connect axillary nerve to phrenic nerve.
For elbow intercostal nerves are better option,2,3,4 intercostal nerve are used to coapt to musculocutaneous nerve. Post op patient is advised to have deep breathing exercise for 3 to 4 hrs daily for approximately one year ,walk 6 to 8 km daily.
Pedicled vascularized ulnar nerve is used to for hand sensation and to connect and functioning muscle transfer for finger flexion in future. Ulnar nerve is connected to contralateral C7 mostly anterior division.
Supplemental procedure to improve function are wrist and thumb arthrodesis, tenodesis procedure of various kinds.
Pan brachial palsy are mostly avulsion at surgical rootlets so nerve transfer is major way of restoring function.If C5 is ruptured then there is many other way of reconstructing plexus and restoring function.
Dr Adhishwar Sharma
MB,BS , MS General Surgery PGIMER Chd
Mch Plastic Surgery
Fellowship in Hand and microvascular Surgery
8860650846, adhishwar7@gmail.com
brahmanandclinic.com
Pan brachial plexus injury is often associated with major trauma the management of life threatening injuries takes precedence and brachial plexus is tackled later on.
Initial surgery is nerve transfer for shoulder and elbow function. Nerve transfer for shoulder is used innervate suprascapular and shoulder muscle.. Spinal accessory is used for suprascapular nerve. It is a pure motor nerve which powers trapezius muscle, and distal portion is used preserving proximal trapezius. For deltoid muscle Phrenic nerve is used via nerve graft. Around 10 cm nerve graft is used to connect axillary nerve to phrenic nerve.
For elbow intercostal nerves are better option,2,3,4 intercostal nerve are used to coapt to musculocutaneous nerve. Post op patient is advised to have deep breathing exercise for 3 to 4 hrs daily for approximately one year ,walk 6 to 8 km daily.
Pedicled vascularized ulnar nerve is used to for hand sensation and to connect and functioning muscle transfer for finger flexion in future. Ulnar nerve is connected to contralateral C7 mostly anterior division.
Supplemental procedure to improve function are wrist and thumb arthrodesis, tenodesis procedure of various kinds.
Pan brachial palsy are mostly avulsion at surgical rootlets so nerve transfer is major way of restoring function.If C5 is ruptured then there is many other way of reconstructing plexus and restoring function.
Dr Adhishwar Sharma
MB,BS , MS General Surgery PGIMER Chd
Mch Plastic Surgery
Fellowship in Hand and microvascular Surgery
8860650846, adhishwar7@gmail.com
brahmanandclinic.com
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