Download PDF
Semin Plast Surg 2004; 18(4): 285-299
DOI: 10.1055/s-2004-837255
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Strategy in Obstetric Brachial Plexus Palsy: The Aachen Experience

Jörg Bahm1 , Michael Becker1 , Catherine Disselhorst-Klug2 , Sy Williams2 , Lars Meinecke2 , Hans Müller3 , Bernd Sellhaus3 , J. M. Schröder3 , Günter Rau2
  • 1Euregio Reconstructive Microsurgery Unit, St Franziskus Hospital Aachen
  • 2Helmholtz Institute for Biomedical Technologies, RWTH University, Aachen
  • 3Institute for Neuropathology, RWTH University, Aachen, Germany
Further Information

Publication History

Publication Date:
06 December 2004 (online)

Also available at
    Permissions and Reprints

ABSTRACT

We present our personal experience with 650 children suffering from obstetric brachial plexus palsy. We describe the related surgery including early microsurgical nerve reconstruction and later tendon and muscle transfers. We discuss our clinical approach, the indications and timing for surgery, the technical details of primary and secondary surgery in our hands, and the possible outcome. We emphasize that both clinical work and research work need an interdisciplinary team approach and that diagnostic, therapeutic, and prognostic improvement is based on the refinements of our (micro)surgical skill and the continuous exchange of information between specialized centers.

KEYWORDS

Obstetric brachial plexus palsy - microsurgery - tendon/muscle transfers - cocontraction - movement analysis

REFERENCES

  • 1 Bahm J. Obstetric brachial plexus palsy-clinics, pathophysiology and surgical treatment.  Handchir Mikrochir Plast Chir. 2003;  35 83-97
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Gilbert A, Hentz V R, Tassin F L. Brachial plexus reconstruction in obstetric palsy: operative indications and postoperative results. In: Urbaniak JR Microsurgery for Major Limb Reconstruction. St Louis; Mosby 1987: 348-364
    Search in Google Scholar
  • 3 Borrero J L, De Pawlikowski W. Obstetrical Brachial Plexus Palsy. Lima; Althaus 2002
    Search in Google Scholar
  • 4 Millesi H, Rath T, Reihsner R, Zöch G. Microsurgical neurolysis: its anatomical and physiological basis and its classification.  Microsurgery. 1993;  14 430-439
    PubMedSearch in Google Scholar
  • 5 Clarke H M, Al-Qattan M M, Curtis C G, Zuker R M. Obstetrical brachial plexus palsy-results following neurolysis of conducting neuromas-in-continuity.  Plast Reconstr Surg. 1996;  97 974-984
    CrossrefPubMedSearch in Google Scholar
  • 6 Terzis J K, Papakonstantinou K C. Management of obstetric brachial plexus palsy.  Hand Clin. 1999;  15 717-736
    PubMedSearch in Google Scholar
  • 7 Birch R. Medial rotation contracture and posterior dislocation of the shoulder. In: Gilbert A Brachial Plexus Injuries. London; Martin Dunitz 2001: 249-260
    Search in Google Scholar
  • 8 Hoffer M M, Wickenden R, Roper B. Brachial plexus birth palsies-results of tendon transfers to the rotator cuff.  J Bone Joint Surg Am. 1978;  60 691-695
    PubMedSearch in Google Scholar
  • 9 Gilbert A, Romana C, Ayatti R. Tendon transfers for shoulder paralysis in children.  Hand Clin. 1988;  4 633-642
    PubMedSearch in Google Scholar
  • 10 Price A, Tidwell M, Grossman J A. Improving shoulder and elbow function in children with Erb's palsy.  Semin Pediatr Neurol. 2000;  7 44-51
    CrossrefPubMedSearch in Google Scholar
  • 11 Chuang D C, Ma H S, Wei F C. A new strategy of muscle transposition for treatment of shoulder deformity caused by obstetric brachial plexus palsy.  Plast Reconstr Surg. 1998;  101 686-694
    PubMedSearch in Google Scholar
  • 12 Curtis C, Stephens D, Clarke H M, Andrews D. The Active Movement Scale: an evaluative tool for infants with obstetrical brachial plexus palsy.  J Hand Surg [Am]. 2002;  27 470-478
    CrossrefPubMedSearch in Google Scholar
  • 13 Mallet J. Paralysie obstétricale du plexus brachial.  Rev Chir Orthop. 1972;  58(suppl 1) 115-204
    PubMedSearch in Google Scholar
  • 14 Gilbert A. Evaluation of results in obstetric brachial plexus palsy: systems for the shoulder. Presented at the International Meeting on Obstetric Brachial Plexus Palsy, Heerlen The Netherlands; 1993
    Search in Google Scholar
  • 15 Bahm J, Meinecke L, Brandenbusch V, Rau G, Disselhorst-Klug C. High spatial resolution electromyography and video-assisted movement analysis in children with obstetric brachial plexus palsy.  Hand Clin. 2003;  19 393-399
    CrossrefPubMedSearch in Google Scholar

Jörg BahmM.D. 

Euregio Reconstructive Microsurgery Unit, St. Franziskus Hospital

Morillenhang 27, D 52074 Aachen, Germany