Dr. Francisco Soldado has recently been recognized as a World Expert in brachial plexus by ExpertScape, a platform that awards this merit based on academic research. We interviewed the doctor so that he could explain to us what this appointment means on a professional and personal level.
What does it mean to be recognized as a “World Expert” in a specific pathology?
It means reinforcing our professional strategy. Patient care must be the main objective. Our actions must be focused on obtaining the greatest possible improvement for the patient. That is, to seek excellence in knowledge and practice in order to give the best to the patient.
My recommendations are:
- Learn from the best (training) and from each patient (listen to them, mistakes).
- Innovate and research; understand that every patient exam and surgery is an opportunity to grow medicine.
- Record and quantify everything you do.
- Operate a sufficient patient volume, and with as much complexity as possible (practice).
- Share our progress and our failures.
When is such recognition granted?
On the Expert Scape platform, the recognition is based on the academic part. It is quantitative and objective and therefore not tainted by influences or politics.
You are recognized in this field when you are above 99.9% of the academics in the plexus of the world. It’s proud of you.
What exactly is brachial plexus pathology and when does it occur?
The brachial plexus is a network of nerves that arises from the cervical spinal cord and gives movement and sensation to the upper extremity. It is mainly injured by trauma, and less frequently by tumors or other causes.
Trauma basically occurs in two situations: injuries to the plexus in adults, which usually occur after a traffic accident, and obstetric or birth brachial palsy, which occurs in the baby due to traction on the nerves during childbirth.
What are the problems for the patient and why is it important to intervene?
In the child the main problem is the loss of mobility (paralysis). Sensitivity is usually recovered even without surgery.
In the adult, both mobility and sensitivity can be a problem and, also very important, pain.
In order to reinnervate a muscle, so that the nerve can reach it again and function, we have to operate within a year of the injury. Otherwise the surgery would not work. However, each age and type of injury has some specific time specifications.
How is the brachial plexus operated and what are the guarantees of success?
The management is very different in the infant and in the adult. On the other hand, the techniques (nerve grafts, nerve transfers) are the same. It is easy for a surgeon used to treating babies to treat an adult, but the opposite is not the case.
In infant surgery, which affects part of the plexus, the chances of obtaining functional results, and allowing the baby to lead a normal life, are more than 90%. When the entire plexus is affected (complete or total obstetric brachial palsy), we achieve hand mobility that allows bimanual activities in 70% of children.
In the adult, operated before 4 months of the injury, in partial paralysis the results are similar. In complete paralysis we can basically opt to flex the elbow, control the shoulder and eliminate pain; it is much more serious.