[Possibilities for reconstruction in brachial plexus paralysis: neurotization]

Reinnervation by nerves other than the brachial plexus are necessary if avulsion of the roots prevents neural reconstruction of the brachial plexus itself, or if functional recovery is unsatisfactory and further reconstruction is necessary for improvement. The foreign nerves mostly used today for these neurotizations are the accessory nerve, the deep cervical plexus, the intercostal nerves and, more and more, the contralateral C7 spinal nerve. Our own experimental studies have demonstrated future concepts for reconstructions in very desperate cases to improve the final functional outcome in the useless extremity: cross-over reinnervation from the contralateral side, end-to-side nerve coaptation, and induction of sprouting by offering free muscle transplants to the regenerating nerve.