Ballistic Injuries of the Brachial Plexus.

Ballistic injuries of the brachial plexus represent a challenging clinical dilemma. Given the unique pathophysiology of ballistic penetrating trauma, time-sensitive management of vascular and bony stabilization must be balanced with a nuanced understanding of nerve injury and recovery in both space and time. After immediate life and limb-saving interventions, an evidenced-based approach affords multiple options for irrecoverable nerve injury, including exploration and grafting, distal nerve transfers, and tendon transfers. An assessment of pertinent imaging and diagnostic studies, patient access, and social/psychological dimensions of care enables surgeons and patients to proceed with optimal treatment of these devastating upper limb injuries.