Brachial plexus injury: when to amputate?

Amputation of the upper limb was performed in 20 out of 750 patients with traction lesions of the brachial plexus between August 1969 and June 1991. Urgent amputation was necessary in three patients with irreparable vascular injury and in two more because of overwhelming sepsis. Thirteen patients chose amputation of their flail and useless arm. Two patients have been lost to follow-up. Urgent amputation is indicated when perfusion of the limb cannot be restored, for sepsis, and for a limb which is so severely injured that there can be no prospect for a return of any function. Elective amputation is performed at the patient's request and may be considered as an element of rehabilitation. The pain of preganglionic injury of the brachial plexus is not relieved by amputation.