Emergency versus delayed repair of severe brachial plexus injuries.

Emergency or early surgery for brachial plexus injury is advisable because emergency nerve surgery is technically easier and because the overall results are better. In cases involving vascular injury, preoperative arteriography is indispensable. The blood supply must be reestablished and the brachial plexus completely explored and, if possible, repaired. In cases not involving vascular injury, violent trauma with fractures of the shoulder often produces lesions in the same brachial plexus. Regardless of associated vascular or bone injuries, brachial plexus lesions should be repaired within the first days after injury (provided that there are no contraindications related to age or general health). If combined vascular and nerve injuries are involved, immediate emergency surgery is mandatory. With early surgery, exploration is easier, shorter grafts are needed, and neurotization is possible in lesions in which the roots have been pulled out.