Restoration of prehension using double free muscle technique after complete avulsion of brachial plexus in children: a report of three cases.

Abstract

Brachial plexus injury in children, excluding birth palsy, is relatively rare and seldom reported. We report our technique, the results of this procedure, and problems we encountered in treating children with brachial plexus injury. From 1999 through 2002, we treated 3 children with complete avulsion of the brachial plexus due to trauma by using double free muscle technique (DFMT) with a nerve transfer procedure using the contralateral seventh cervical nerve root transfer to reconstruct prehensile function. There were 2 boys aged 5 and 11 years and a girl aged 4 years. All patients were followed up for at least 3 years after the surgery. All the transferred muscles survived without any vascular complications and were reinnervated successfully. The average active range of elbow flexion was 125 degrees (range, 90 degrees - 145 degrees ). The average total active range of motion of the fingers was 69 degrees (range, 40 degrees -102 degrees ). All patients obtained voluntary prehensile function and could use the reconstructed hand for activities of daily living. They were able to lift and carry light objects with the reconstructed hand and heavy objects with both hands. The results of DFMT for reconstruction of BPI in children were encouraging. Appropriate postoperative rehabilitation under close supervision is important to obtain useful prehensile function.