Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions

The selection of patients who will benefit from peripheral nerve surgery continues to evolve. The evaluation of patients with peripheral nerve problems, and the indications and timing of surgery are reviewed. This includes patients with transections, lesions in continuity, entrapments, tumors, injection injuries, and birth palsies. The treatment outlined for patients with peripheral nerve and brachial plexus injuries is based on a comprehensive clinical and electrodiagnostic evaluation complemented by imaging studies. A systematic approach to the surgical management of these neural lesions has evolved at our institution, based in part on extensive experience with intraoperative recording of nerve action potentials (NAPs) and a resultant large number of referrals. Advanced microsurgical techniques including use of grafts have expanded the scope of peripheral nerve surgery. These advances coupled with intraoperative electrophysiologic measurements have improved outcomes.