Procedure
Surgical exploration and nerve reconstruction as soon as possible is understandable given the slow rate of nerve regeneration. The nerve cells sprout at a rate of approximately 1 mm per day and only when the cells reach their end organ (muscle) can the muscle function recover. Unfortunately, denervated muscles are subject to a degenerative process which is usually irreversible after 12-18 months, i.e. the muscle function is then permanently lost.
The first operation for a plexus injury consists of exploration of the nerve plexus with visualization of the injured nerves. Depending on the extent of the injury, the nerves can be reconstructed with grafts from the lower leg or the injured arm itself (in the case of peripheral injuries) or so-called nerve transfers can be performed. Nerve transfers are operations that are used in cases where the nerves in the spinal cord cannot be reconstructed. Healthy and dispensable nerves are used to replace the damaged nerves and thus ensure recovery of muscle function. In the case of panplexus injuries, i.e. the loss of all nerves in the limb, we can redirect nerves from the healthy opposite side to the injured arm in order to restore the function of the muscles (contralateral C7 transfer).
At our clinic, we offer the entire spectrum of reconstructive plexus surgery and also have the option of assessing nerve function during the operation using various intraoperative techniques. In the case of plexus injuries, for example, intraoperative electrophysiology can be used to assess whether a questionably torn root is still functional and can be used for nerve reconstruction.
In addition to surgical technique and planning, correct advice for patients with plexus injuries is crucial. For example, age plays a key role: young patients are much more likely to have an operation that results in satisfactory function after these serious injuries. In older patients, however, the risk-benefit ratio of a complex reconstruction must be weighed up very carefully.
Prognosis
Plexus injuries are drastic injuries that have a massive impact on the lives of the patients affected. Due to the long distance to the end organ and the associated long recovery time, the final results of plexus reconstructions are often only visible after several months or even years. Follow-up operations are also often necessary if the primary reconstruction does not lead to a satisfactory result. Pain is another problem that is often difficult for patients to deal with. Unfortunately, avulsion injuries in particular are often associated with severe nerve pain, which can severely impair the quality of life of affected patients.
