Special Considerations Regarding the Treatment of Brachial Plexus Lesions

Abstract

Brachial plexus lesions constitute, due to the anatomical characteristics, the most serious lesions affecting the peripheral nervous system. The reason for this lies not only in the complicated anatomical relationships at the time of surgery, but, even more, in the metabolic environment of the damaged nerves. The region of damage is localized in the proximity of the cell body, and as a result of retrograde degeneration, a considerable amount of neurons can be lost which no longer regenerate. In comparison with lesions of peripheral nerves, such as the median nerve at the wrist, the neurons in the plexus have considerably more difficult tasks to perform in the case of lesions or interruptions. The cell body must render a higher metabolic activity. While in the case of a median nerve lesion at the wrist approximately 10% of the intracellular substance of the altered neuron must be rebuilt, more than 50 % of the intracellular substance is lost in brachial plexus continuity lesions (Fig. 1).