Obstetric lesions of the plexus brachialis

Reconstructive operations

An obstetric lesion of the plexus brachialis can occur in the course of a natural birth. Risk factors are a high birthweight of more than 4,000g, a prolonged birth process or a forceps delivery. In total, around 1-5 children are affected per 1,000 births.

A stretching, rupture, or tearing-out of the nerves from the spinal canal can occur in the context of these injuries. Depending on the extent of the injury, an operation on the nerves is necessary. If the nerves have been stretched, they are neurolysed in the framework of a microsurgical operation – the pressure on the nerve cord is relieved by scar tissue. If nerve cords have been torn, the gaps that arise can be bridged with nerve transplants. In the event of nerves being torn out of the spinal cord, a nerve fibre transfer from other nerves is necessary. An operation on the brachial neuroplexus is not necessary with all infants. An experienced clinical examination is required, however, for the indication of a conservative procedure and/or of the operation.

Many parents are told that 95% of these injuries improve without special treatment. Is this true?

Prof. Millesi’s more than 40 years of experience with children and adults suffering from such injuries, and also the scientific literature on this subject, show that this assumption is more than exaggerated! Overall, it is important for the parents to know that an obstetric lesion of the brachial neuroplexus entails long-term treatment. A primary operation to the nerves here only lays the foundations for healthy development. It is important for us that we accompany our patients until the end of their growth. This allows us to observe the development and progress of our patients and to improve it if necessary.