Traumatic Lesions of the Brachial Plexus: Surgical Treatment of Remote Sequelae

Sidorovich R., Shipay ņ.

Scientific Practical Centre of Neurology and Neurosurgery, Minsk, Belarussian

 

As for remote sequelae of traumatic lesions of the brachial plexus, one of the most urgent problems of their treatment is restoring a function of an upper extremity.

We performed transposition of the following muscles: the broadest muscle of the back (BMB) - 21 cases, musculus pectoralis major (MPM) - 5 cases, the triceps - 4 cases. They were transposed on an anterior surface of a shoulder for restoration of active flexion of a forearm. Tendons of radial and ulnar flexors of a hand were transposed on a forearmís straightening surface with fixing the radial flexor tendon to the extensor tendons of the 2nd-5th fingers and the ulnar flexor tendon to a tendon of the long extensor of the thumb (7 cases); it was done with the purpose of restoring extension of a hand and fingers. It allowed to obtain excellent and good results.

If impaired flexion of a forehand and impaired extension of a hand, fingers were associated, we used a combined double-stage method of muscle and tendon transposition. The first stage consisted in transposition of MPM (3 cases), BMB (2 cases) on a forearmís anterior surface for ensuring its active flexion in an elbow joint. After restoration of a volume and strength of active flexion we performed tendon-muscle transposition for restoring extension of a hand and fingers. We got excellent (4 cases) and good (1 case) results. Active flexion of a forearm and extension of a hand and fingers were restored.

A combined method of muscle and tendon-muscle transposition, used in remote sequelae of traumatic lesions of the brachial plexus, is an effective means of restoring an upper extremity function in proximal and distal segments.