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Cirugía Plástica Ibero-Latinoamericana

On-line version ISSN 1989-2055Print version ISSN 0376-7892

Abstract

GARCIA-GARCIA, Federico  and  CARDENAS-MEJIA, Alexander. Usefulness of transoperative electrophysiological monitoring in the treatment of brachial plexus injuries. Cir. plást. iberolatinoam. [online]. 2017, vol.43, n.3, pp.305-312. ISSN 1989-2055.  http://dx.doi.org/10.4321/s0376-78922017000400012.

Background and Objective

Brachial plexus injuries are one of the most devastating lesions for the patient. The presurgical low specificity and positive predicted value in the electrophysiology studies are the main indication to perform an intraoperative nerve recording. Despite the great progress obtained, the surgical treatment results in patients with brachial plexus lesions are fare from an ideal scenario. Nevertheless, the surgical management obtains better results than nonsurgical treatment.

The aim of this study is to analyze the postoperative results of patients with brachial plexus surgery with and without transoperative electrophysiological monitoring.

Methods

From 2007 to 2014 medical files and preoperative and postoperative videos of our patients with brachial plexus injury were evaluated, those patients underwent neurolysis, nerve grafts and/or nerve transfer. Patients with muscle transfer or arthrodesis were excluded. Two groups were formed, depending on the performance or absence of intraoperative nerve recording. Their pre and post-surgery videos were reviewed and rated according to a scale based on the Narakas and Raimondi valuation.

Results

Twenty five patients were obtained. All postoperative assessments showed a statistically significant improvement (p <0.05) regardless either of the presence or the absence of intraoperative nerve recording. During the postoperative evaluation of the group with intraoperative monitoring, shoulder external rotation and movement of the middle fingers obtained statistically significant improvement (p <0.05), in comparison to the group without nerve recording. In the postoperative evaluation, 53.3% of patients presented with intraoperative nerve recording arose in 1 or more of the ranges of the rating scale; whereas in patients without it only 20% had increased. None of the patients gave a lower score while postoperative assessment.

Conclusions

Even though the surgical treatment did not reestablish the complete patient movement, it reached better postsurgical outcomes. Draws attention to intraoperative nerve monitoring studies provide better clinical outcomes in the postoperative period in patients with brachial plexus injury.

Keywords : Brachial plexus; Braquial plexus injury; Electrophysiology; Evoked potentials.

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