Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 45:
Direct Surgery of Traumatic Lesions of the Brachial Plexus

Between 1970 and 1980, this surgical field was intensely developed by European teams and a few Japanese teams. Because of Narakas' initiative in Kleinert's and Kutz's center in Louisville, Kentucky,8 this type of surgery reached the United States.

The accumulation of clinical data from all the European teams bearing on several thousands of operated cases has allowed comparison and evaluation of various techniques. At the present time, direct surgery of the brachial plexus yields results that are still inconsistent as far as motoricity is concerned; however, it has already increased our knowledge of the physiology and function of the upper limb. This, in turn, has helped shape a strategy for prioritized repair of muscle groups that are fundamentally important for upper limb function. Furthermore, this type of surgery has brought comfort to patients who experienced pain following brachial plexus rupture or avulsion. Although direct surgery is a difficult and lengthy procedure for the surgeon, who may feel quite alone, the patient benefits from the help and advice of the whole team. The main goals of the endeavor are to maintain the upper limb in satisfactory trophic condition during the period of nerve regeneration, and to assess as early as possible the ability of the patient to resume work.

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