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Double team approach to brachial plexus surgery
Francesco Gargano, MD1; Julia Katarincz, MD2; Silvio Podda, MD3; Scott Schmidt, MD1
1Plastic Surgery, Brown University, Providence, RI; 2Orthopedic Surgery, Brown University, Providence, RI; 3PLastic surgery, St Joseph Hospital, Paterson, NJ
Introduction: Brachial plexus surgery is a complex and demanding procedure requiring surgical skills and long operative time. Few studies have been published regarding optimizing time and outcomes in brachial plexus surgery. The aim of our study is to assess the advantages of having a double operating team approach and analyze surgeons position during the procedure.
Patients and methods: Six patients with brachial plexus palsy were analyzed. Three of them underwent surgery operated by a double team and three by single team The operating time of the procedure and the position of the two teams at the operating table were measured for each patient. Values were compared to assess any statistical significance.
Results: The mean operating time was 280Êmin with surgery operated by a single team performing between one nerve transfer without nerve graft harvesting and 256Êmin in the patient group operated on by two teams in which three anastomoses were performed along with sural nerve harvest. Position of the two teams at different moment during the procedure are illustrated. No perioperative complications were noted.
Discussion and conclusion: Brachial plexus surgery performed by a double team allows the reduction of the operating time and thus minimizes the drawbacks associated with lengthy surgery such as perioperative bleeding and infection. Reimbursement of two teams appears therefore justified by decreased complications rate and surgical time. Surgeon fatigue is another important factor to be considered in decreasing complication rates: microsurgical suturing is easier when performed at the end of a shortened intervention and shared by two senior surgeons. This approach improves the operating conditions and guarantees better outcomes
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