Background-Traumatic brachial plexus injury is a devastating condition resulting mainly from motor cycle accidents and primarily affecting the young adults. In the past there was a pessimistic attitude in the management of these injuries. However in last two decades with the introduction of microsurgical techniques and advancements in imaging modalities, these injuries are being explored and repaired early with satisfactory to good functional out comes.
Methods-Neurolysis, nerve repair, nerve grafting, nerve transfer, pedicle muscle transfer and functioning free-muscle transfer are the main surgical procedures in the management of brachial plexus injury. An immediate intervention is considered in stab or iatrogenic injuries. All other common high velocity traction injuries are initially observed for a spontaneous recovery. If there are no signs of recovery by three months, surgery is indicated, as further delay will affect the ultimate results. In global brachial plexus palsy with all root avulsions, intervention is even earlier, as chances of spontaneous recovery are practically nil. Nerve allografts with new immunosuppressant (FK-506) are being used where there is paucity of autografts. Direct replantation of avulsed spinal roots into the spinal cord is a new area of research in brachial plexus reconstruction. Use of fibrin glue in nerve coaptation has considerably reduced the operating time
Results– Good results are expected with early intervention in upper plexal lesions. Results are favorable with short nerve grafts, distal nerve transfers, and intraplexal neurotization. The aim in global brachial plexus palsy is to restore the elbow flexion and provide a stable shoulder. Restoration of a fully functional and sensate hand is still far from being a reality.
Conclusion– The management of brachial plexus injury remains a challenging problem. Functional results have considerably improved in the past two decades with the incorporation of microsurgical techniques in nerve surgery, and advancements in anesthesia. Following microsurgical reconstruction many of these patients are expected to return to their original work and amputation is no longer considered a treatment option. However, despite advances in understanding of pathophysiology of nerve injuries and advent of microsurgical techniques, the outcomes of repair have still not reached its zenith.
