[The microsurgical treatment of traumatic lesions of the brachial plexus]

The article deals with the results of examination and surgical treatment of 213 patients with various forms and levels of traumatic damage of the branchial plexus. Five levels of damages are suggested: I--preganglionic; II--postganglionic damage of the spinal nerves and primary trunks of the brachial plexus; III--damage of the secondary trunks in the clavicular region; IV--damage of the distal parts of the brachial plexus; V--isolated damages of the initial parts of the peripheral nerves. The authors describe surgical management by the method of differentiated neurotization with nerves arising from different segments of the spinal cords, by-passing the brachial plexus. Pathological changes in the region of the trauma, the character and level of the damage, the condition of the circulatory system, the presence or absence of pain, the applied rehabilitation therapy, the duration of the disease, the patient's age, and other factors have a marked influence on the outcome of the operation. Charts of distribution of the nerve fibres of the brachial plexus in the nerve trunks were compiled more exactly on the basis of data obtained during the operative intervention and autopsy.