Brachial Plexus Reconstruction

Injury to the brachial plexus (BP) can lead to devastating motor and sensory deficits of the upper extremity. Growth of modern microsurgery has led to development of a diverse set of techniques for BP reconstruction, including local repair in an end-to-end or end-to-side fashion, nerve grafts (intraplexus vs extraplexus), and nerve transfers. The decision process for BP reconstruction is first and foremost dependent on the extent and degree of injury. Additional factors to consider include anatomical location of the injury as well as the availability of nerve donors in cases where the degree of damage does not allow for a local tension-free repair. Proper preoperative workup, including history, physical exam, and electrodiagnostic evaluation, is essential to surgical planning. Furthermore, intraoperative nerve monitoring and subsequent postoperative rehabilitation are crucial to achieving positive functional outcomes. This chapter aims to review BP injury etiologies and options for reconstruction; to describe preoperative, intraoperative, and postoperative considerations; and to provide an algorithm for the surgical management of BP injuries.