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Surgical Management of Brachial Plexus Injuries

Written by Dr Richard Lawson FRACS - Hand Surgeon

 
Surgical management of the brachial plexus injury


Most injuries to the brachial plexus spontaneously recover, but a small proportion does not, and these patients are best managed with surgery. The aim of the surgery is to reconnect the muscles that have lost input from their nerves. In some cases, the nerves can be repaired, either directly with sutures between the nerve ends, or much more commonly with a nerve graft, which is a strip of nerve which is taken from the leg and placed between the two ends of the nerve.

In other cases the nerve had actually been pulled out of the spinal cord (avulsed) and in these cases the nerve cannot be repaired. Injuries like these require a different approach, which involves taking undamaged nerves and joining them to the damaged nerve. Another approach typically used for injuries where all nerve roots are avulsed is to aim for some finger and elbow movement using muscles taken from the leg and connected to functioning nerves such as those that supply the rib muscles.

In some cases, the muscles that are supplied by the nerves have wasted away to the point that reconnecting them with their nerves will not lead to any return of function. In these cases, it is sometimes possible to take a muscle (which is not missed) from the leg, and to place it into the arm, to take the place of the wasted muscle. The new healthy muscle is joined up to arteries and to nerves in the arm.

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