The Surgical Treatment of Brachial Plexus Injuries in Adults

Learning Objectives After studying this article, the participant should be able to: 1. Describe the mechanisms and pathophysiology of posttraumatic brachial plexus palsies in the adult population. 2. Evaluate clinically a patient with posttraumatic brachial plexus palsy and incorporate in the diagnosis results from electrophysiologic and radiologic studies. 3. Formulate a preoperative treatment plan, describe various reconstructive strategies, and identify the usual postoperative follow-up of the patient. 4. Anticipate the possible functional outcome of brachial plexus reconstruction and identify the factors affecting the outcome. Posttraumatic brachial plexus palsy is a severe injury primarily affecting young individuals at the prime of their life. The devastating neurological dysfunction inflicted in those patients is usually lifelong and creates significant socioeconomic issues. During the past 30 years, the surgical repair of these injuries has become increasingly feasible. At many centers around the world, leading surgeons have introduced new microsurgical techniques and reported a variety of different philosophies for the reconstruction of the plexus. Microneurolysis, nerve grafting, recruitment of intraplexus and extraplexus donors, and local and free-muscle transfers are used to achieve optimal outcomes. However, there is yet no consensus on the priorities and final goals of reconstruction among the various centers. (Plast. Reconstr. Surg. 106: 1097, 2000.)