Surgical treatment of traumatic brachial plexus injuries

The brachial plexus injuries are frequent caused by nerve roots avulsion after high-energy traffic accidents and generally affect young males, resulting in neural deficits with high potential for permanent disability. The present study has an objective to perform a review the literature concerning the surgical treatment of traumatic lesions of the brachial plexus, emphasizing the key techniques and indications. It discusses the four most commonly used surgical techniques: direct repair in acute lacerations, external neurolysis, nerve grafts and nerve transfers. Furthermore, analyzes the anatomy, pathophysiology and the factors that influence the functional recovery: age, the interval between injury and surgery, the state of coaptation of the two sites, nerve grafts, scarring, ischemia and the degree of lesion nerve root. A direct reparation is most used in acute lacerations and the nerve transfer have been shown the most effective treatment, especially in combination with the nerve grafts.