Surgical treatment of brachial plexus injury

Brachial plexus injury has been attracting increasing attention in recent times, partly because of an increasing incidence arising out of higher survival rates for patients after polytrauma and also due to higher success rates for surgical treatment. Obstetric brachial plexus palsy has recently become the focus of interest for a number of articles. Many injured elements of the brachial plexus are reconstructed by a donor nerve transferred onto the recipient nerve, i.e. by neurotization. This method leads to better outcomes than suture of the injured nerve in the proximal part of the plexus, the main advantage of which is the opportunity to place the suture as close to the muscle as possible. There are two newer methods - Oberlin's technique and end-to-side anastomosis. It remains unclear as to which donor nerve is better to use for neurotization in specific recipients due to a lack of large, randomized clinical trials. Generally, neurotization using the intraplexal nerve as a donor of motor nerve fibres is more successful than neurotization using the extraplexal nerve.