Introduction
In cases of plexus injuries that do not spontaneously recover, nerve surgery can restore movement and sensation to the affected arm.
Indications
Major plexus injuries are observed for the first 3 months. If after that period there is no improvement then the injuries are best treated with nerve reconstruction.
Preoperative Instructions
Brachial plexus surgery is done under general anaesthetic and will need at least on night in hospital. Blood thinning medication would need to be stopped in consultation with your doctor. The hospital will be in contact about the timing of your admission and fasting requirements.
Procedure
Surgical exploration of the brachial plexus involves an incision in the neck, sometimes extending down to the arm depending on the severity of the injury. If nerve grafts are used, then an incision is made in the back of one or both calves to harvest the expendable sural nerves. These donor nerves are used to bridge the gaps in the brachial plexus caused by the injury. Sometimes nerve transfers are used – this involves the transfer of an expendable donor nerve to re-innervate an important injured nerve. In some settings, brachial plexus reconstruction can be done with multiple nerve transfers without an incision in the neck.
Postoperative Instructions
Usually the arm is immobilized in a sling for 2-3 weeks, after which physiotherapy restarts to preserve the passive motion of the limb. It takes at least 3-4 months before any nerve recovery can be seen, and often at least a year before that becomes functional.
Risks
Brachial plexus reconstruction is major surgery requiring a long anaesthetic. With nerve transfers there is a risk of some loss of function from the donor site of the transfer.
Treatment Alternatives
There is no effective treatment for brachial plexus injuries to offer functional recovery of the muscles other than surgery.