Surgical management of brachial plexus injuries

Exploration of the brachial plexus was done as an elective procedure in 56 patients with complete or partial lesions. The indications were based on clinical findings, a Tinel-Hoffman sign indicating that at least one root was available for direct repair, or a cessation of signs of progressive recovery. In young patients with supraganglionic lesions and evidence of root avulsion, nerve grafts from intercostals to various portions of the plexus were done. Evaluation of the results of motor functions showed that 38 of 54 (70 percent) recovered a useful motor function in at least one important area. There were two postoperative hematomas leading to delayed healing and failure of nerve recovery. Two patients had temporary loss of power in uninvolved muscles but both recovered satisfactory function. Only one patient had a persistent pain syndrome. Two failures were due to the late operation (19 months after injury) and one because of a 15 cm. which was grafted.