Nerve transfers in adult brachial plexus injuries: My methods

Spinal nerve avulsions lead to the lack of available central connections and become irreparable lesions. Nerve transfer provides possibly the only chance for the functional restoration in the early stage (within 5 months after injury). This article discusses brachial plexus injuries in 541 adults who were treated by nerve transfer during 1990 to 2000. Nerve transfers were performed from other areas of the brachial plexus (intraplexal transfer), from nonplexal nerves (extraplexal transfer), or by end-to-side neurorrhaphy. Most nerve transfers were mainly for motor restoration, and a few for sensory restoration. The reconstructive strategies in these avulsion injuries varied from case to case, in part because of the surgeon's philosophy, new knowledge, and facilities. Other important factors include elapsed time from injury to surgery, injury severity, age, and motivation. Finally, the availability of knowledge and skilled rehabilitation is critical.