|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Table 45-1. Results of Brachial Plexus Grafts
Physical therapy must start at 3 weeks postoperatively, when grafts are considered healed. Physical therapy aims to conserve the amplitude of movements of shoulder, elbow, and digital chains.
In the case of partial lesions (for example, a paralysis of C5 and C6 with integrity of the C8 and TI roots), we advocate the use of Pacquin's helicoid splint. This splint stabilizes the shoulder, re-establishes lateral rotation, and above all places the elbow in favorable position, at the patient's initiative, so that the hand which is kept functional by C8 and T1, can be used. This helicoid splint avoids functional exclusion of the partially paralyzed upper limb and allows the patient an early return to work while waiting for nerve regeneration.
When the hand is definitively condemned (for example, after intradural avulsion of C7, C8 and TI), it is preferable to lateralize the patient by using the contralateral limb as the dominant limb if it was not before the accident, and to examine the possibility of the patient adapting himself to a new type of work. 55
For the past 2 decades, brachial plexus surgery has made significant progress, thanks to a better knowledge of the anatomy of the plexus, to the amelioration of diagnostic means such as electromyography, myelography, CT scanning and magnetic resonance imaging.
Technical improvements developed in peripheral nerve surgery made it possible to graft plexus lesions under good conditions. A recent beneficial development in Europe has been the introduction of biologic glues.
The accumulation of data from various European teams has facilitated the adoption of coherent operative protocols that prioritize the essential functions of elbow and shoulder.
Experience shows that these patients must be quickly explored surgically, in any case before the sixth month. This is the best way to ameliorate pain conditions and to take advantage of nerve regenerative capacity. Direct surgery of the brachial plexus, however, does not stop at the door of the operating room; it necessitates constant follow-up reviews by teams of physical therapists, ergotherapists, prosthestists, manufacturers, and others to facilitate return to work.
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