First 100 brachial plexus surgeries in Angola: Population impact and lessons learned.

Purpose: The authors present a multicenter national prospective cohort of neonatal and adult BPI in Angola from January 2021 to December 2025, focused on clinical data (patient profile and surgical results using the MRC scale) and lessons learned (geographic distribution and logistics) that can be applied to other low- and lower-middle-income countries. Methods: This is a national multicenter prospective cohort of neonatal and adult BPI from January 2021 to December 2025. All patients were evaluated prior to surgery using clinical evaluation, always performed by the same nerve surgeon. All adult patients underwent electromyography. Neonatal patients were evaluated using clinical assessment only. All surgeries were performed by the same surgeon, and postoperative clinical follow-up for assessment of surgical results was also performed by the same surgeon. Results: Sixteen neonatal BPI cases were included; 10 were female, and the mean age was 13 months (range, 8-18 months). One patient had a complete injury and underwent reconstruction with grafts; the other 15 had upper trunk injuries and underwent the Oberlin procedure. All pediatric surgeries were performed in Luanda, and all patients were from Luanda. The mean follow-up was 12 months (range, 8-28 months), and an MRC grade of 3 or higher was achieved in 7 patients (43%). Among the 86 adult patients operated on, 76% had complete BPI, and 43% underwent distal transfers with grafts; data regarding type of injury and surgical approach are presented in Tables 2 and 3 The mean time from injury to surgery was 14 months (range, 6-24 months). Almost all patients had neuropathic pain (85 patients, 98%); among these, 78 (90%) showed improvement in pain. Discussion and conclusion: This series shows very low rates of functional recovery, which is an expected result given the long interval from injury to surgery in both adult and pediatric patients. The focus of this paper is on the lessons learned, highlighting that a surgical team alone is not sufficient, with the need for a dedicated pediatric team, public-private partnerships, and a team for secondary procedures. These first 100 brachial plexus surgeries represent only a small step in the development of brachial plexus surgery in Angola, and the lessons learned need to be applied to improve patient care.