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The Functional Benefits of Reconstructive Surgery for Complete Lesions of the Brachial Plexus in Adults

The majority of complete lesions of the brachial plexus in adults are caused by motor vehicle accidents. Most of these patients have no more than two nerve roots available for grafting, due to pre-ganglionic avulsion of the other nerve roots from the spinal cord. Thus, extraplexal neurotizations often have to be used to make up for the loss of axons. A non-dominant, helper arm that can be used in a supportive role can be reconstructed under these circumstances, but hand function will remain poor despite reconstruction. In stab wounds the whole injury is post-ganglionic and can be reconstructed with better functional results, and recovery of finger flexion may occur (Dunkerton and Boome, 1988). The goals of surgery are to provide elbow flexion with musculocutaneous nerve sensation, protective sensation in the median nerve distribution, a stable shoulder, and, if possible, finger flexion and wrist extension. The nerve grafts and neurotizations are concentrated in this order of preference rather than being spread thinly with the risk of failure. After reconstruction, biceps function of M3+ or better is achieved in 48% (Terzis et al., 1999) to 63% (Bentolila et al., 1999) of cases, rotator cuff function in 75% (Terzis et al., 1999), deltoid in 40% (Terzis et al., 1999) and triceps in 30% to 35% (Bentolila et al., 1999; Terzis et al., 1999).