EJMS

Abstract

Anatomical variations of the brachial plexus are so common, it is crucial to look for them before surgical correction of the different injuries of the plexus or infraclavicular plexus block. This study was done to identify the variations of the brachial plexus and highlight their clinical significance. The materials of this study included 40 cadaveric specimens obtained from the Faculty of medicine, University of Alexandria which were dissected to find the variations of the different parts of the plexus and 20 patients undergoing different surgical procedures for repair of brachial plexus injuries. Anatomical results: variations were found in 60% of cases and involved all the stages of the plexus, prefixed pattern was found in 30% of cases, postfixed in 15% and both prefixed and postfixed in 2.5%. Communicating branches existed between the different parts of the plexus as well as abnormal origin of the branches. Clinical results: 6 patients with complete supraclavicular lesions had good results (60%) while 3 patients with partial supraclavicular lesions had good results (60%) and all patients with infraclavicular lesions had good results. Preoperative ultrasonographic and electrophysiological assessments of the plexus are mandatory because of the high prevalence of anatomical variations. The type of repair is guided by intraoperative electrophysiology to assess neural continuity and function. The brachial plexus is very variable, even in the same person; the right and left sides may not be similar. These variations were recorded by many authors in a percentage similar to the results of this study. Disagreement exists between different studies as regards the location and description of the variations. The anatomical basis of brachial plexus variations should be kept in mind, especially while performing surgical exploration, especially in the axillary and cervical regions and when interpreting clinical symptoms following trauma or tumor events.