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Results of Hand Re-innervation, a Follow-up Study
Willem Pondaag, MD, PhD and Martijn J.A. Malessy, MD, PhD, Neurosurgery,
Leiden University Medical Center, Leiden, Netherlands

Methods Retrospective analysis of prospectively collected data was performed on the results of nerve repair for hand function in infants with obstetric brachial plexus lesions. A ten year cohort was investigated (2000-2009). Included were all infants with a flail arm who underwent nerve surgery by one of the authors. Excluded were infants with positive reaction to direct intra-operative electrical stimulation of C8 and/or T1 (n=5). 32 infants were identified and analyzed. The Raimondi score (0-5) at last follow-up was used to express the result for hand function, or - if applicable - the last examination prior to tendon transfers to wrist or fingers. A Raimondi score of 3 or better was defined as a useful hand function. Results Mean age of surgery was 4.2 months, mean follow-up was 86 months (range 44-148). 20 of 32 children (63%) recovered to Raimondi 3 or better. In 23 of 32 infants the distal targets of the nerve reconstruction were the C8 and / or T1 root (or its root filaments). The results in this subgroup were better (78% reached Raimondi >= 3), compared with the infants in whom a more distally located nerve was targeted (e.g. medial trunk, or contributions to the median nerve). Results decrease with an increasing number of root avulsions. Conclusions 1) Hand function recovery is feasible in children with an obstetric brachial plexus lesion, and should be the first priority of nerve reconstruction 2) The outcome is more favourable when the nerve reconstruction aimed at a proximal target nerve

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