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CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2025; 20(01): e9-e15
DOI: 10.1055/s-0044-1801398
Original Article

Surgical Treatment of Obstetric Plexus Lesions by Direct Coaptation Compared to Sural Nerve Graft Interposition

Justus Mai 
1   Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
,
Christa Kunigunde Raak
1   Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
2   Center for Integrative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
,
Thomas Ostermann
3   Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Witten, Germany
,
Jörg Bahm
4   Division of Plexus Surgery, Clinic for Plastic Surgery, Hand and Burn Surgery, RWTH Aachen University, Hospital Aachen Germany, Aachen, Germany
,
Wolfram Scharbrodt
1   Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
2   Center for Integrative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Abstract

Background To date, there are no uniform guidelines for the treatment of obstetric plexus lesions in German-speaking countries. An end-to-end direct suture after resection of trunk neuroma is recommended for surgical treatment if tension-free coaptation is possible, whereas the use of autologous nerve grafts bridging the gap between the adaptation margins is advised by consensus if tension-free coaptation is impossible.

Objective The aim of the study was to investigate which reconstruction strategy may provide a better recovery of motor function for patients after obstetric brachial plexus lesion.

Methods This study compared postoperative functional outcome after obstetric brachial plexus palsy from a patient collective including a total of 43 children. The surgical techniques of plexus reconstruction by end-to-end coaptation versus the use of sural nerve interposition graft have been analyzed. Therefore, the degrees of active motion of abduction and external rotation in the shoulder joint, and flexion in the elbow joint were assessed using the neutral zero method.

Results For abduction in the shoulder joint, significantly better motor function was found in the group with direct sutures (p = 0.033). For external rotation in the shoulder joint and flexion in the elbow joint, there was no statistically significant difference between the groups (p = 0.284 and p = 0.270, respectively).

Conclusions This study could not demonstrate absolute superiority of either reconstruction method. Slight evidence was found for a better functional outcome for plexus reconstruction by direct coaptation. Further arguments support a better suitability of plexus reconstruction by direct suture if its use is justifiable.

Keywords

obstetric brachial plexus palsy - direct coaptation - sural nerve graft - microsurgery

Ethical Approval

The Ethics Committee of Witten/Herdecke University has given its consent to the collection of the data (No. 241/2019).




Publication History

Received: 05 July 2023

Accepted: 09 December 2024

Article published online:
15 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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