[Primary reconstructive operation in surgical treatment of perinatal brachial plexus palsy in children]

Abstract

Perinatal brachial plexus palsy (PBPP) constitutes a serious medical problem. PBPP treatment consists in conservative and operative procedures. The latter one is usually divided into primary operative procedures, conducted in the initial stage of child's life (aiming at suture of brachial plexus nerves in the early stage of life) and secondary (aiming at elimination of functional limitations, osseous deformations, articular contractures occuring at later stages of life). A significant but also controversial aspect arises at determining the date of operation performance and also at defining factors classifying a child for surgical operation and details concerning the application of definite operative method. The following microsurgical methods are applied in microsurgical reconstruction of PBPP: neurolysis (external and internal), end-to-end nerve suture, free nerve grafts. The most complicated are injuries which result in root avulsion from the spinal medulla. In such cases the avulsed roots are connected to nerves of cervical plexus, applying the method of neurotization. The reason of numerous controversies around the choice of treatment method for PBPP patients is the desire to balance procedures aiming at the proper functioning of the patient in future.