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The Surgical Treatment of Total Brachial Plexus Avulsion Injury-A Retrospective Study of 73 Patients

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ClinicalTrials.gov Identifier: NCT03162393
Recruitment Status : Completed
First Posted : May 22, 2017
Last Update Posted : May 22, 2017
Sponsor:
Information provided by (Responsible Party):
Kaiming Gao, Huashan Hospital

Brief Summary:
Brachial plexus avulsion injury (BPAI) caused by traction injury, especially total root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. We need to find an relatively optimal surgical treatment.

Condition or disease Intervention/treatment
Brachial Plexus Injury Procedure: nerve transfer

Detailed Description:
Brachial plexus avulsion injury (BPAI) caused by traction injury, especially total root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Nerve transfer is the most successful method for repairing cases of brachial plexus root avulsion. Phrenic nerve transfer, accessory nerve transfer, intercostal nerve transfer and contralateral C7 transfer are all well-established technique in the treatment of certain severe brachial plexus lesions in adults. As reported in previous articles, shoulder function, elbow flexion, elbow extension, and wrist and finger function have been restored successfully by spinal accessory, phrenic, intercostal, and contralateral C7 nerve transfers . However, the results of just one function reconstruction were evaluated in those articles. Few studies were found that focused on the whole function reconstructions of the affected limb. In different medical organizations even in our department, many different surgical strategies were used in treating total BPAI patients and the results differed significantly. Here, we investigated the results of different commonly used nerve transfer in order to determine a relatively optimal surgical strategy for treatment of total BPAI patients.

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Study Type : Observational
Actual Enrollment : 73 participants
Observational Model: Case-Only
Time Perspective: Retrospective
Official Title: The Optimal Surgical Strategy for the Treatment of Total Brachial Plexus Avulsion Injury Patients
Actual Study Start Date : January 1, 2016
Actual Primary Completion Date : December 31, 2016
Actual Study Completion Date : December 31, 2016

Group/Cohort Intervention/treatment
group 1
phrenic nerve transfer to musculocutaneous nerve; spinal accessory transfer to suprascapular nerve; intercostal nerve transfer to triceps branch, radial nerve and axillary nerve; contralateral C7 nerve transfer to median nerve
Procedure: nerve transfer
group 2
phrenic nerve transfer to musculocutaneous nerve; spinal accessory transfer to suprascapular nerve; intercostal nerve transfer to triceps branch and radial nerve; contralateral C7 nerve transfer to median nerve
Procedure: nerve transfer
group 3
spinal accessory transfer to suprascapular nerve; intercostal nerve transfer to triceps branch, radial nerve and axillary nerve; contralateral C7 nerve transfer to median nerve and musculocutaneous nerve
Procedure: nerve transfer
group 4
spinal accessory transfer to suprascapular nerve; intercostal nerve transfer to triceps branch and radial nerve; contralateral C7 nerve transfer to median nerve and musculocutaneous nerve
Procedure: nerve transfer
group 5
spinal accessory transfer to suprascapular nerve; intercostal nerve transfer to musculocutaneous nerve, radial nerve and axillary nerve; contralateral C7 nerve transfer to median nerve and triceps branch
Procedure: nerve transfer
group 6
spinal accessory transfer to suprascapular nerve; intercostal nerve transfer to musculocutaneous nerve and radial nerve; contralateral C7 nerve transfer to median nerve and triceps branch
Procedure: nerve transfer



Primary Outcome Measures :
  1. physical examination [ Time Frame: at least 3 years post-operative ]
    the motor and sensory function recovery of the recipient nerves



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Ages Eligible for Study:   12 Years to 60 Years   (Child, Adult)
Sexes Eligible for Study:   All
Sampling Method:   Non-Probability Sample
Study Population
Between 1999 and 2006, a total of approximately 200 patients with posttraumatic total BPAI underwent surgical exploration and reconstruction of the brachial plexus and 109 agreed to participate in our study. Seventy-three patients were enrolled and 36 were excluded.
Criteria

Inclusion Criteria:

  • global root avulsion brachial plexus injury, a minimum postoperative interval of 3 years, all operations performed by the same medical team, nerve transfer was the only reconstruction method.

Exclusion Criteria:

  • diabetes, Volkmann contracture, fracture on the affected limb, rib fracture, brain trauma.
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Responsible Party: Kaiming Gao, Doctor, Huashan Hospital
ClinicalTrials.gov Identifier: NCT03162393    
Other Study ID Numbers: NSFC-H0605/81501871
First Posted: May 22, 2017    Key Record Dates
Last Update Posted: May 22, 2017
Last Verified: May 2017

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Kaiming Gao, Huashan Hospital:
brachial plexus; avulsion injury
Additional relevant MeSH terms:
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Wounds and Injuries
Fractures, Avulsion
Fractures, Bone