Secondary Reconstruction

The infant is followed each year after the nerve repair, and secondary surgical procedures are performed depending on the progress of the functional recovery after rehabilitation.

Fig. 12.4. In C7-C8 and T1 avulsions combined with C5-C6 ruptures, the proximal stumps of C5 and C6 are connected to the anterior-lateral and anterior-medial cords with the use of nerve grafts.

Fig. 12.5. In total pulsies with avulsions of all the roots except the C5, a graft connects C5 root to the anterior-lateral cord and the intercostal nerves are used to neurotize the anterior-medial cord.

Fig. 12.5. In total pulsies with avulsions of all the roots except the C5, a graft connects C5 root to the anterior-lateral cord and the intercostal nerves are used to neurotize the anterior-medial cord.

Fig. 12.6. A protective splint immobilizing the upper body, the neck and head is used after the surgical procedure.

• Medial contracture of the arm can be treated with subscapularis release.

• The lack of abduction and external rotation can be improved with a latis-simus dorsi transfer to the cuff.

• In case of a poor result at the level of the shoulder, a trapezius transfer can be proposed (if the spinal accessory nerve has been spared) to improve abduction of the joint.

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