[Surgical indications in lesions of the brachial plexus]

The development of microsurgery and the improved technique of nerve grafting brought new hope in cases of brachial plexus injury. Especially the Tinnel-Hofmann sign is a very helpful parameter in preoperative examination. Cases without any regeneration or no advancement should be operated between 3 and 6 months after the injury. Neurolysis or nerve grafting should be performed. In cases of avulsion of the roots a reneurotisation by nerve transfer is the technique of choice. The intercostal nerves are connected with important parts of the brachial plexus. Also in late cases (after 6 months) an epineurectomy and neurolysis may help to encourage further regeneration. Useful recovery could be achieved in a fairly high number of patients by restoration of continuity by nerve grafts or neurolysis. The functional results can further be improved by exploiting all available reconstructive techniques.