Primary surgery for global OPBI

Forum for parents of injured who are seeking information from other parents or people living with the injury. All welcome
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katep
Posts: 1240
Joined: Mon Mar 29, 2004 3:20 pm

Primary surgery for global OPBI

Post by katep »

Most BPI specialists used to believe that primary surgery could not restore function to the hand in globally injured children was not possible. For this reason, nerve reconstruction (primary surgery) has traditionally favored the shoulder and upper arm.

In the last few years, numerous experts in BPI treatment have publicly disagreed with this belief. I can't say that strongly enough: Parents out there with children who are globally injured and are considering primary surgery right now need to know that many specialists now believe there is hope for these childrens' hands. But nearly all agree that treatment must be pursued quickly for globally injured children.

My statements are based on publicized "opinions" of numerous specialists in the field (a few are listed below). Don't just take my word for it. Get the papers and read them for yourself (if you need help with that, email me). Email the authors (email addresses for authors are usually included in the paper) and ask them questions directly; find out if their opinions have changed and if so, why. Many parents have successfully consulted with top specialists across the country and around the globe this way. And if you have already chosen a doctor for your child, papers such as those listed below can be a "jumping off" point for discussions with them. Oftentimes you can learn just how informed your doctor is through these types of discussions!

In the end, BPI is still such a new field, you just can't expect universal agreement or recommendations - the specialists simply do not all agree, either with what they consider believable or acceptable "evidence" or the various interpretations of it. You will still have to take that "leap of faith" in choosing who to go with. But - for us, at least - knowing that our doctor had considered the expertise and findings of other doctors, and was even be willing to discuss them with us, helped us feel more comfortable making difficult and controversial decisions for our own child.

Kate
(Our son did not have primary surgery, but another procedure which also had divergent opinions in the medical community. So I do understand the dilemma)

References:

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum
Pondaag W, Malessy MJ: Recovery of hand function following nerve grafting and transfer in obstetric brachial plexus lesions, Journal of Neurosurgery, 2006 Jul;105(1 Suppl):33-40

"CONCLUSIONS: Useful hand function was restored in 69% of the patients in the presented series in whom reanimation of the hand could be fully attributed to the surgical reconstruction. The authors conclude that restoration of hand function should be the first goal of nerve repair in infants with a flail arm caused by an OBPL, but that the optimal strategy for different types of lesion remains to be determined."

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum
Haerle M, Gilbert A: Management of complete obstetric brachial plexus lesions. J Pediatr Orthop 24:194–200, 2004

From abstract: "the results at the level of the hand were encouraging, showing 75% useful results after 8 years, even in patients with avulsion injuries of the lower roots."

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum
Hentz, Vincent R: Congenital brachial plexus exploration. Techniques in hand & upper extremity surgery [1089-3393] yr:2004 vol:8 iss:2 pg:58 -69

"Reconstructive goals for upper plexus injuries include shoulder and elbow control. The paramount goal for babies with global palsies is hand function. "
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