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Brachial plexus management

Brachial plexus management. Kamrani R. Sh. M.D. 3 rd annual POTA congress March 2008. How to manage a BPI victim. Introduction Multiple trauma patient Young active male with long standing problem. Stiff hand Inappropriate physiotherapy. How to manage a BPI victim. Introduction

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Brachial plexus management

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  1. Brachial plexus management Kamrani R. Sh. M.D. 3rd annual POTA congress March 2008

  2. How to manage a BPI victim • Introduction • Multiple trauma patient • Young active male with long standing problem

  3. Stiff hand Inappropriate physiotherapy

  4. How to manage a BPI victim • Introduction • Multiple trauma patient • Young active male with long standing problem • Realistic outcomes • Prognostic factors • After injury • After treatment

  5. prognosis

  6. Prognosis

  7. How to manage a BPI victim • Introduction • Multiple trauma patient • Young active male with long standing problem • Realistic outcomes • Prognostic factors • After injury • After treatment • Socioeconomic aspect of the treatment • Psychological aspects of the treatment

  8. How to manage a BPI victim • Open wounds • Sharp injury • Bullet injury • Closed injuries

  9. Sharp injury

  10. Chest tube

  11. Junction of trunk and cords • Bullet wound Clavicle osteotomy

  12. Laceration

  13. Nerve repair and graft

  14. Laceration

  15. Nerve graft

  16. Bullet injury

  17. velocity of gun shot

  18. Closed injury, (tractional injuries)

  19. Closed injury, (tractional injuries) • Early exploration • Underobservation • Decision for the time of delay exploration • Decision for the type of the treatment • Late recostruction Straight on Brachial plexus

  20. Closed injury, (tractional injuries) • Early exploration • Underobservation • Decision for the time of delay exploration • Decision for the type of the treatment • Late recostruction Peripheral reconstruction

  21. Closed injury, (tractional injuries) • Early exploration vascular reconstruction

  22. Pseudoaneurism

  23. Based on severity • Closed injury, (tractional injuries) • Early exploration • Underobservation First 6-12 weeks Stabilization of the patient Stabilization of the injury Evaluation of the improvement After 2-3 months No improvement; exploration Progressive improve; wait & watch Non-anatomic recovery; explor.

  24. Closed injury, (tractional injuries) • Early exploration • Underobservation • Decision for the time of delay exploration • No recovery • After 6-12 weeks (based on the severity of the trauma) • Progressive improvement • Wait for further improvement • Non-anatomic recovery • Exploration before 9-12 months

  25. Closed injury, (tractional injuries) • Early exploration • Underobservation • Decision for the time of delay exploration • Decision for the type of the treatment

  26. Treatment options • Neurolysis • Nerve repair • Nerve graft • Nerve transfer • Tendon transfer • Arthrodesis • Functional muscle flaps

  27. Treatment options • Neurolysis • Nerve repair • Nerve graft • Nerve transfer • Tendon transfer • Arthrodesis • Functional muscle flaps Straight on Brachial Plexus Peripheral reconstruction

  28. Treatment options’ indication • Neurolysis • Nerve repair • Nerve graft • Nerve transfer • Tendon transfer • Arthrodesis • Functional muscle flaps Straight on Brachial Plexus Early exploration Delay exploration Peripheral reconstruction Late reconstruction Danger of more damage Failure is obvious

  29. Treatment options’ indication • Neurolysis • Nerve repair • Nerve graft • Nerve transfer • Tendon transfer • Arthrodesis • Functional muscle flaps

  30. Treatment options’ indication • Neurolysis • Nerve repair • Nerve graft • Nerve transfer • Tendon transfer • Arthrodesis • Functional muscle flaps

  31. Gun shot injury

  32. After neurolysis from scar tissue

  33. Treatment options’ indication • Neurolysis • Nerve repair • Nerve graft • Nerve transfer • Tendon transfer • Arthrodesis • Functional muscle flaps

  34. Treatment options’ indication • Neurolysis • Nerve repair • Nerve graft • Nerve transfer • Tendon transfer • Arthrodesis • Functional muscle flaps

  35. Treatment options’ indication • Neurolysis • Nerve repair • Nerve graft • Nerve transfer • Tendon transfer • Arthrodesis • Functional muscle flaps

  36. Motor cycle accident open wound

  37. Vertebral foramen C6 C5

  38. Accessory to superascapular

  39. Oberlin nerve transfer

  40. Root avulsion

  41. Upper brachial

  42. Pherenic nerve

  43. Accessory Injured upper trunk Superascapular nerve

  44. Oberlin nerve transfer Biceps m. Anastamosis Ulnar n.

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