Surgical treatment of brachial plexus injuries.

Ninety-nine consecutive patients with brachial plexus injuries were operated upon over a period of 8 1/2 years. Among them, 70% sustained traction injuries. The surgical procedures included neurolysis in 35, excision of a lateral neuroma in six and interfascicular sural nerve grafting in 27 patients. In 25 patients, after an exploration, no further surgical procedure was carried out. In four patients, an intercosto-musculocutaneous anastomosis, and in two a trapezius muscle transplant were carried out. Just over two-thirds (68%) of the patients were operated upon 6 months after the injury. Water soluble contrast myelography was performed in 60 patients. These included patients where a root injury had been diagnosed clinically or electrophysiologically. MRI was performed in 14 patients to visualize root avulsions and distal lesions. Operative confirmation of MRI findings were obtained in more than 85% of patients. While an early improvement was seen in patients where only a neurolysis was required, at longer follow-up, gratifying results were recorded even in patients with interfascicular grafts of 6-8 cm length. All 49 patients who came for follow-up and in whom a definitive surgical procedure had been carried out improved. Of these patients, 61% showed near normal or satisfactory functional recovery. The other patients were followed for periods of less than 1.5 years and may show further improvement with time.