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The Use of Collagan Conduits in Treatment of Brachial Plexus Birth Palsy: a Comparative Cohort Study
Felicity G. Fishman, MD1; Andrea S. Bauer, MD2; Michelle A. James, MD2; Ann E. Van Heest, MD1; (1)University of Minnesota, (2)Shriners Hospital for Children Northern California
Shriners Hospital for Children Northern California, Sacramento, CA, USA

INTRODUCTION:

Brachial plexus birth palsy (BPBP) has traditionally been treated with sural nerve grafting, but the development of collagen conduits has led to alternative reconstructive options. We hypothesized that the treatment of BPBP with neuroma excision and either sural nerve grafting or application of a collagen conduit would lead to equivalent outcomes, including active movement scale (AMS) scores and time to return of anti-gravity biceps (AGB) function.

MATERIALS & METHODS:

Data was collected by two institutions for infants undergoing sural nerve grafting or collagen conduit reconstruction for BPBP. Ten patients at one institution underwent reconstruction with collagen conduits. All brachial plexus reconstructions at the other institution were performed using sural nerve grafts. Each case that underwent reconstruction using a collagen conduit was manually matched to a control subject that underwent reconstruction using a sural nerve graft. Twenty-two total patients were matched (8 cases, 14 controls) on the basis of age at surgery, Narakas classification and intra-operative findings. Preoperative AMS scores, AMS scores at 1 year and final follow up were compared, along with time to return of AGB function. We applied bivariate conditional logistic regressions to assess associations between techniques of brachial plexus reconstructions and our outcome measures.

RESULTS:

Preoperative AMS scores were better in control subjects than cases, likely reflecting different practices between institutions. Preoperative shoulder flexion (SF) AMS averaged 2.5 in controls and 1.5 in cases. Similarly, average preoperative elbow flexion (EF) for control and case subjects was 2.1 and 0.3, respectively (p=0.015). Average SF at 1 year was 4 in the control group and 2.1 in the case group (p=0.031). Average SF at 3 years in the control and case groups was 4.4 and 4.7, respectively. Average EF at 3 years was 6.4 in the control group and 4.4 in the case group (p = 0.040). Average time to return of AGB function was 495.3 days in the control group and 1093.3 days in the case group (p=0.000).

CONCLUSIONS:

A significant difference was noted in the AMS scores for SF at one year postoperatively, with superior SF in the control patients, but there was no difference at 3 years. Similarly, there was a significant difference in the time to return of AGB function, with a shorter interval noted in the control subjects. However, we hesitate to draw a definitive conclusion on the superiority of one procedure as there were significant preoperative differences in each group.


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