Abstract
Brachial plexus injuries are one of the most complex nerve injuries. Each of these injuries has its own unique characteristics as well as typical findings. During the first 6 months after the injury (immediate reconstruction), a broad spectrum of surgical techniques is available: nerve grafts, nerve transfers, tendon transfers, free functioning muscle transfer, etc. When the time from injury to surgery is greater than 9–12 months (delayed or secondary reconstruction), some of these reconstructive options are not available. While reconstructive options offered are often based on surgeon preferences and his/her educational background, it seems best to optimize outcomes by combining a variety of surgical techniques spanning different surgical disciplines in a team approach to reconstruction.
This chapter will attempt to highlight the current strategies and techniques for an immediate brachial plexus injury. As an example, the upper trunk scenario will be reviewed. Patient selection, the timing of surgery, prioritization of restoration of function, and the available donor nerves will be discussed.
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Preoperative shoulder abduction (MOV 9480 kb)
Preoperative elbow flexion (MOV 11996 kb)
Preoperative hand function (MOV 4719 kb)
Intraoperative exploration of supra- and infraclavicular brachial plexus (MOV 36884 kb)
Intraoperative dissection of the FCU-fascicle from the ulnar nerve. This fascicle will be coapted to the biceps branch of the musculocutaneous nerve (MOV 32056 kb)
Eighteen months follow up results after distal nerve transfer (ulnar fascicle to biceps branch) for elbow flexion and sural nerve graft (from C5 root to axillary and suprascapular nerves) for shoulder reconstruction performed 4 months post upper trunk injury (MOV 15448 kb)
Eighteen months follow up results after distal nerve transfer (ulnar fascicle to biceps branch) for elbow flexion and sural nerve graft (from C5 root to axillary and suprascapular nerves) for shoulder reconstruction performed 4 months post upper trunk injury (MOV 15804 kb)
Eighteen months follow up results after distal nerve transfer (ulnar fascicle to biceps branch) for elbow flexion and sural nerve graft (from C5 root to axillary and suprascapular nerves) for shoulder reconstruction performed 4 months post upper trunk injury (MOV 18508 kb)
Eighteen months follow up results after distal nerve transfer (ulnar fascicle to biceps branch) for elbow flexion and sural nerve graft (from C5 root to axillary and suprascapular nerves) for shoulder reconstruction performed 4 months post upper trunk injury (MOV 22436 kb)
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Pindur, L., Maldonado, A.A. (2022). Adult Immediate Brachial Plexus Reconstruction. In: Gravvanis, A., Kakagia, D.D., Ramakrishnan, V. (eds) Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-23706-6_59
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DOI: https://doi.org/10.1007/978-3-030-23706-6_59
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