United Brachial Plexus Network, Inc.

HAS ANYONE EXPERIENCED THE BPI DOCS NOT AGREEING WITH EACH OTHER?
MY SON MAY OR MAY NOT NEED SURGERY DEPENDING WHO YOU ASK?
DOES THE SURGERY (MOD Q.) TOTALLY HELPED REGAIN FUNCTION 100%
I HAVE HEARD MOD Q. BUT, DOES ANYONE HAVE SOME GOOD WEBSITES TO INFORM MYSELF
I WANT TO KNOW IF THE PARENTS CAN BE IN THE OPPERATING ROOM??????
HAS ANYONE HAD SURGERY WITH BAD RESULTS??? I AM LEANING ON THE IDE OF SURGERY WE HAVE DONE THE WAIT GAME AND I FEEL IF SURGERY WILL HELP?? HAS ANYONE WISHED THEY HAD NOT DONE IT????

Mod quad is just a name given by one particular doctor/hospital for a secondary procedure. Other doctors do the same things, or elements of them, but call them different names. Do the doctor/s that do not agree with MQ have other suggestions? How old is your son? What is his function level? Does the doctor recommending surgery say if your son will need more surgery down the track? MQ used to be said to avoid the need for further surgery, but so many kids who have had it seem to go on and have more surgery I don't think that's the case any more. I would be interested to hear each doctors reasons for and against, people here can only speak of their own experiences, the doctors see many more cases than we do.
The only way to check how effective certain surgeries may be is to check with other people whose kids have had the surgery(bearing in mind each child/injury is different) and to some extent check results that have been published. Some doctors don't publish results so that doesn't always help. Some doctors have their own websites, but these are obviously somewhat biased towards their own methods!
Some doctors are comparing results and working together to find the best treatment/surgery, doctors I know are involved with this international study include Dr Waters in Boston and Dr Kozin at Shriners in PA.
Good luck in your search for answers

The ModQuad (and L'Episcopal & Hoffer's procedures) includes some muscle releases and tendon transfers. It is biomechanically impossible that function is not lost when muscles are transferred! For instance, the latissimus dorsi usually adducts and internally rotates the shoulder. If it is transferred into an external rotator, it no longer does it's original job. That's a fact.

Now, the "fuzzy" part of secondary surgery comes when the muscles being considered for transfer are causing problems by being too strong, or the shoulder is badly deranged to start with so they can't work effectively, or weakness in another area effectively limits the use of these muscles. In those cases, the loss of the original function of some muscles *may not* be noticeable. They be more effective and contribute more in their "new" function than if they had been left in place.

It is because of this potential trade-off, and the real difficulty in "forseeing" what future recovery or future malformation of the should joint might bring that makes it very difficult to decide on secondary surgery. That's primarily why doctors disagree. You should ask the ones who say "wait" why they recommend waiting: do they see surgery in the future but a possibility of avoiding it? What do they see as the risks of "acting now" vs waiting? And you should ask the ones who say "act now" the same questions. Do they see a possibility of avoiding surgery in the future? What are the risks of "waiting" vs "acting now"?

I can promise... they still aren't going to agree! But you might be able to better figure out whose philosophy you are more comfortable going with, according to which types of risks you are comfortable taking for your child. Not enough is known about the various choices for this injury, so unfortunately every decision you make is going to be a risk and a leap of faith

Kate

http://www.drnathbrachialplexus.com/sur ... /index.php
this is a great website for information. my daughter is ROBPI. she has had 1 surgery to date - muscle release and tendon transfer - which has helped a great deal
i think BPI docs are generally the same as regular docs - as far as opinions - not all will think that surgery is needed while others will.
as far as being in the operating room - it will probably be up to the hospital, some will allow it some won't