par Bahm, Jorg 
Référence Journal of Brachial Plexus and Peripheral Nerve Injury, Elsevier, Vol. 2, page (315-329)
Publication Publié, 2015-04
Référence Journal of Brachial Plexus and Peripheral Nerve Injury, Elsevier, Vol. 2, page (315-329)
Publication Publié, 2015-04
Partie d'ouvrage collectif
| Résumé : | Brachial plexus (bp) injuries in childhood are either related to a difficult birth process in a macrosomic newborn or to a breech delivery or, at any age, to traffic accidents.Upper or all roots may be affected by nerve elongation, rupture, and/or root avulsion. Clinical follow-up and analysis of motor and sensory recovery deliver major decision criteria for further treatment. Neurophysiologic measurements are of limited decisional power and MRI/myelo-CT studies only help to visualize avulsed roots.In mild and well-recovering partial bp lesions, conservative physical and occupational therapy might be sufficient. Severe lesions, eventually including (partial) bp root avulsion(s), require early microsurgical nerve reconstruction including a tailored combination of neurolysis, direct nerve stump sutures, interpositional autologous grafts, and/or nerve transfers using intra- and extraplexic proximal donors. Optimization of donor morphologic quality, the number and coaptation quality of grafts, and the postoperative rehabilitation affect the functional outcome. Secondary surgery may be indicated to enhance muscle strength by muscle transfers, to release soft tissue and joint contractures, and to correct positional deformities. Children are affected by impaired limb growth and functional integration, but also by psychosocial problems arising in multiple individual manners. This chapter aims to associate a personal surgical experience over 15 years with a literature overview and discussion of critical clinical and technical issues. |
