Recent Advances in the Treatment of Brachial Plexus Birth Injury | Journal CME Article-Journal CME Article: Recent Advances in the Treatment of Brachial Plexus Birth Injury Video 3

Video Transcription

The brachial plexus of an infant can be reconstructed with soral nerve grafts and fiber and glue alone without the need for sutures.  This allows for excellent coaptation of the grafts, even in awkward situations. This patient has an upper and middle trunk lesion of the left brachial plexus.  Soral nerve grafts are cut to length in place to minimize wastage. All of the grafts to be applied to one root can be cut before any glue is applied to allow for more efficiency.  The wound can be rinsed with saline one last time before any glue is added. Our preference is to add drops of each of the two solutions in sequence to avoid clogging  the needle in the combined apparatus. After the drops of glue are applied, you can adjust the position of the grafts to exactly the way you'd like with forceps.  Grafts arising from the C6 root and the C5 root are cut to length and glued in position in sequence. The middle trunk is reconstructed first as it is in the depths of the wound.  The microscope has been repositioned to show the coaptation of the accessory nerve to the suprascapular nerve, glued with a couple of drops of both solutions.  Additional drops of glue can be applied to reinforce the repair sites. The entire upper and middle trunks of the brachial plexus have been reconstructed with  soral nerve grafts and a transfer of the accessory nerve to the suprascapular nerve. No sutures have been used and the wound can now be closed.

Video Summary

In the video, an infant's brachial plexus is reconstructed using soral nerve grafts and fiber and glue, eliminating the need for sutures. This method allows precise graft placement even in difficult areas. The patient has a lesion on the left brachial plexus's upper and middle trunk. Grafts are precisely cut to avoid waste, and saline rinses precede glue application to prevent needle clogging. The C6 and C5 roots are reconstructed first, followed by the accessory nerve to suprascapular nerve transfer. Glue reinforces the repair, completing the reconstruction without sutures, readying the wound for closure.

Keywords

brachial plexus reconstruction

soral nerve grafts

sutureless technique

nerve transfer

fiber and glue