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All infants were followed for at least 2.5 years (range 2.5\u20137.3 years) with an average follow\u2010up of 4.2 years. Assessment was performed using the Toronto Active Movement scale. Surgical procedures included neurolysis, neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostals and contralateral C7 root. Satisfactory recovery was obtained in 37.1% of cases for shoulder abduction; 54.3% for shoulder external rotation; 75.1% for elbow flexion; 77.1% for elbow extension; 61.1% for finger flexion, 31.4% for wrist extension and 45.8% for fingers extension. Using the Raimondi score, 18 cases (53%) achieved a score of three or more (functional hand). The mean Raimondi score significantly improved postoperatively as compared to the preoperative mean: 2.73 versus 1, and showed negative significant correlation with age at surgery. In total, obstetrical brachial plexus palsy, early intervention is recommended. Intercostal neurotization is preferred for restoration of elbow flexion. Tendon transfer may be required to improve external rotation in selected cases. Apparently, intact C8 and T1 roots should be left alone if the patient has partial hand recovery, no Horner syndrome, and was operated early (3\u2010 or 4\u2010months old). Apparently, intact nonfunctioning lower roots with no response to electrical stimulation, especially in the presence of Horner syndrome, should be neurotized with the best available intraplexal donor. \u00a9 2010 Wiley\u2010Liss, Inc. Microsurgery, 2010.<\/jats:p>","DOI":"10.1002\/micr.20726","type":"journal-article","created":{"date-parts":[[2010,1,4]],"date-time":"2010-01-04T16:34:58Z","timestamp":1262622898000},"page":"169-178","source":"Crossref","is-referenced-by-count":32,"title":["Total obstetric brachial plexus palsy: Results and strategy of microsurgical reconstruction"],"prefix":"10.1002","volume":"30","author":[{"given":"Tarek A.","family":"El\u2010gammal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amr","family":"El\u2010Sayed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed M.","family":"Kotb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasser Farouk","family":"Ragheb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waleed Riad","family":"Saleh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramy Mohamed","family":"Elnakeeb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"El\u2010Sayed Semaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,1,4]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199404000-00001"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2007.01.006"},{"key":"e_1_2_1_4_2","first-page":"33","article-title":"Recovery of hand function following nerve grafting and transfer in obstetric brachial plexus lesions","volume":"105","author":"Pondaag W","year":"2006","journal-title":"J Neurosurg"},{"key":"e_1_2_1_5_2","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S0749-0712(21)00264-X","article-title":"An approach to obstetrical brachial plexus injuries","volume":"11","author":"Clarke HM","year":"1995","journal-title":"Hand Clin"},{"key":"e_1_2_1_6_2","first-page":"167","article-title":"Symposium on brachial plexus surgery, Barcelona, March 13 and 14, 1999","volume":"18","author":"Palazzi S","year":"1999","journal-title":"Chir Main"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199803000-00014"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B8.15975"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.83B6.11389"},{"key":"e_1_2_1_10_2","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1111\/j.1469-8749.1988.tb14647.x","article-title":"Surgical management of brachial plexus birth injuries","volume":"30","author":"Hunt D","year":"1988","journal-title":"Dev Med Child Neurol"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.85B3.13651"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1993.79.2.0197"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(88)80063-7"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000170557.13788.D2"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199905000-00006"},{"key":"e_1_2_1_16_2","unstructured":"MarcusJR CurtisCG ClarkeH.External rotation following suprascapular nerve reconstruction in obstetric brachial plexus palsy: Accessory nerve transfer versus C5 grafting. 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