Bionic hand reconstruction after global brachial plexopathies
Global brachial plexus lesions with multiple root avulsions are among the most severe nerve injuries with the consequence of lifelong disability, remind researchers at the Medical University of Vienna, Austria. Luckily, most cases of primary and secondary reconstructions provide a stable shoulder and restore sufficient arm function. The problem is, explain the authors, the restoration of biological hand function, which is still a challenging reconstructive goal. In the current study, the authors present the long-term functional outcomes of 16 patients with global brachial plexopathies who, due to lack of other treatment options, qualified for an innovative technique: the recently introduced concept of bionic reconstruction combining selective nerve and muscle transfers with elective amputation of the functionless hand and its replacement with a prosthetic device.
The final functional outcome measurements were obtained with the Action Arm Research Test (ARAT), the Southampton Hand Assessment Procedure (SHAP), and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.
Partial hand function was restored with bionic reconstruction in all five patients who completed functional assessments. ARAT scores improved from 3.4 to 25.0 (p = 0.043), while SHAP scores improved from 10.0 to 55 (p = 0.042). The improved disability of the patients was suggested by a decrease in DASH scores from 57.9 to 32 (p = 0.042).
This study reports on an algorithm for bionic reconstruction that led to useful hand function in patients who suffer from a stiff, functionless, and insensate hand resulting from global brachial plexopathies and who lack biological treatment alternatives.