Plastic Surgery>>>>>Paediatric plastic surgeryQuestion 1#In obstetrical brachial plexus paralysis (OBPP):
A. Primary suture without tension is frequently possible
B. Internal neurotization should be attempted only when C5 and C6 are ruptured
C. Motion of the extremity should be started immediately after surgery to avoid stiffness
D. Babies who do not recover biceps function by the age of 3 months should be considered for immediate operation
E. Physiotherapy can be discontinued once the biceps start to flex the elbow
Correct Answer is
DComment:Babies who do not recover biceps function by the age of 3 months should be considered for immediate operation.
Also note:
- Primary suture without tension is rarely possible. Nerve grafting is usually necessary for root or trunk ruptures.
- In the presence of root avulsions an internal neurotization should be attempted between different roots, particularly as children seem to have a far greater capacity to accommodate to differential neurotizations.
- When it is not possible to perform an internal neurotization, an external neurotization can be performed using one or more of the following donor nerves in the following order of preference: the pectoral nerves, the intercostal nerves and the accessory nerve.
- The reconstruction should be protected from excessive motion for the first 3 weeks.
- Physiotherapy should be continued up to 2 years of age but then continued by the parents in the form of play and activities of daily living.
- Secondary surgery can be considered when it is clear that recovery following reconstruction is no longer progressing.
References:
1. Gilbert A. Primary repair of the obstetrical plexus. Indian Journal of Plastic Surgery 2005; 38(1): 34-42.