Complete Brachial Plexus Injuries: Review of Surgical Techniques and Functional Outcomes

Abstract

Complete brachial plexus injuries (BPI) are among the most severe and debilitating nerve injuries, often leading to extensive motor and sensory loss in the upper extremity. This paper reviews the surgical management of complete BPI, focusing on nerve transfers, functional muscle transfers, and pain management techniques, such as dorsal root entry zone (DREZ) lesioning. Common nerve transfer options in complete BPI include the spinal accessory nerve SAN to the suprascapular nerve (SSN) transfer for shoulder reanimation, (SAN) to musculocutaneous nerve (MCN), intercostal nerves to MCN, phrenic to MCN for reconstruction of elbow flexion, and contralateral C7 transfer for reanimation of finger and elbow flexion. Functional free muscle transfers, most often utilizing the gracilis, are particularly effective in chronic BPI where nerve grafting or nerve transfers are not possible. DREZ lesioning provides pain relief in chronic neuropathic cases. Early intervention and structured rehabilitation are crucial for optimal outcomes. Effective management of complete BPI requires a multidisciplinary approach. Techniques like nerve grafting, muscle transfer, and DREZ lesioning offer significant potential for recovery, while timing and rehabilitation are crucial to improving outcomes. Continued advancements in surgical methods are promising for improving patient recovery and quality of life.