Journal of Brachial Plexus and Peripheral Nerve Injury最新文献

{"title":"Diffusion Weighted and Diffusion Tensor Imaging: A Clinical Guide","authors":"J. Bahm","doi":"10.1055/S-0038-1669394","DOIUrl":"https://doi.org/10.1055/S-0038-1669394","url":null,"abstract":"Diffusion Weighted and Diffusion Tensor Imaging: A Clinical Guide edited by C. da Costa Leite and M. Castillo [Thieme 2016] Imaging of nerve tissue morphology progressed significantly with the development of magnetic resonance imaging (MRI) technology. A step further is done actually with the diffusion tensor imaging (DTI) applied on MRI signals, where one canvisualizenotonlywhitematterbundles, but also starts to get insight in physiologic processes like brain maturation and nerve regeneration) as well as in pathologies like tumors, infectious diseases, demyelination, injury, and hemorrhage. This is a novel up to date book in a new and thrilling clinical and research field, edited and written by neuroradiologic experts. After a comprehensive review of the underlying physics and the anatomy of supratentorial white matter tracts and their organization, the editors present chapters about imaging of the brain during the first 2 years of life (development and aging changes), before addressing the aforementioned main fields of brain pathology—not without dedicating a separate chapter to the spine and spinal cord diseases. The last chapter even goes beyond the future and deals with even newer developments based on non-Gaussian signal distribution, introducing the research on diffusional kurtosis and diffusion spectrum imaging and their potential applications, trying to improve the representation of crossing axonal fibers and tracts, a serious limitation of DTI images. Every chapter is written very clearly and has a welldefined structure, with beautiful illustrations in order to capture the focus of non-radiologic readers within the new field of imaging and research. Of course, a better visualization of organized tracts and their alteration in pathology and aging will stimulate our pathophysiologic curiosity and drive them to investigate further. For neurologists, potentially hypothetic tissue changes such as in earlyAlzheimer’s disease nowbecome obvious. For neurosurgeons who deal with a vascular pathology or a tumor, the alteration of neighboring tracts is precisely represented. The peripheral nerve surgeon starts to follow in the postoperative course regenerating cones through the morphologic highway of a peripheral nerve structure, recognizable by their clear unidirectional fluid and tissue movement, so precisely identifiable on tractography. DTI is not necessarily expensive, but time consuming. Thus far, it is not a routine procedure either in neuroradiology investigation or in medical cost reimbursement considerations. This book provides quick updates to a lot of concerned physicians and technicians.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"13 1","pages":"e6 - e6"},"PeriodicalIF":0.7,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0038-1669394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47919282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Nerve Sutures in (Extended) Upper Obstetric Brachial Plexus Repair.","authors":"J Bahm,&nbsp;A Gkotsi,&nbsp;S Bouslama,&nbsp;W El-Kazzi,&nbsp;F Schuind","doi":"10.1055/s-0037-1608624","DOIUrl":"https://doi.org/10.1055/s-0037-1608624","url":null,"abstract":"<p><p><b>Background</b>  In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks. <b>Objectives</b>  We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8.4 months. <b>Methods</b>  Analysis of functional results after a minimum of 18 months was conducted using the British Medical Research Council (BMRC) scale. <b>Results</b>  All children reached 60-90° of elbow flexion and 75° of shoulder abduction at already six months after surgery. For those patients having already passed one year post surgery, the mean active shoulder abduction reached 92°, and for those who past the 18 months 124°. We discuss the actual knowledge about nerve coaptation under \"reasonable\" tension including its advantages and drawbacks. <b>Conclusion</b>  This technique may be indicated in preoperatively selected cases of (extended) upper OBPP and may give good functional results.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"12 1","pages":"e17-e20"},"PeriodicalIF":0.7,"publicationDate":"2017-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1608624","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35549697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution and Critics on \"Capnography as an Aid in Localizing the Phrenic Nerve in Brachial Plexus Surgery. Technical Note\" by Combined Ventilator Waveforms Analysis.","authors":"George Georgoulis,&nbsp;Eirini Papagrigoriou,&nbsp;Marc Sindou","doi":"10.1055/s-0037-1608623","DOIUrl":"https://doi.org/10.1055/s-0037-1608623","url":null,"abstract":"Dear Editor, We have recently published a work on the intraoperative identification of fourth cervical (C4) root and phrenic nerve during “difficult” surgery, by changing the ventilator waveforms triggered by electrical stimulation of these anatomic structures.1,2 Reviewing the literature on the domain, we came across the correspondence by Bhakta (October 2008) regarding the article “Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note.”3,4 Having studied the method in a series of 12 patients for C4 root (microsurgical cervical DREZotomy for neuropathic pain after brachial plexus avulsion) and 2 patients for phrenic nerve (transversomegaly of seventh cervical vertebra and brachial plexus tumor), we would like to add our own findings and conclusions in the discussion. In the original article (May 2008), Bhagat et al4 had presentedtheirwork inwhich thechangesoncapnographyelicited byelectrical stimulationof thephrenicnervehadbeen successfully used for the intraoperative identification of the nerve in a series of threepatients. InOctober2008, Bhaktaquestioned the correlation between the changes on capnography and the stimulation, suggesting that various anesthesiologic parameters could have resulted in similar changes. Our own method consists of the combined analysis of capnography and at least one of pressure–time and flow– time curves. In our series, general intravenous anesthesia was used, without neuromuscular blocking agents. As opposed to thepatients in the series ofBhagat et al,where a laryngealmask was used,4 our patients were intubated and ventilated in fully controlledventilationmodeswith tidal volumes of 6mL/kg and frequencies between 11 and 15. No difference of performance was observed between volume control and pressure control modes. No hyperventilation or air leak around the cuff was suspected at any point. No poststimulation hemodynamic variabilitywas observed. The electrical stimulationwas always performed at around 1 mA. Under these fully controlled conditions, capnography showed a sensitivity of 100% in the detection of the stimulation of either C4 root or phrenic nerve. The disadvantages of the capnography curve alone are that it can only be interpreted during expiration, as values during inspiration are zero, and there is normal delay between the occurrence of ventilatory events and their appearance on the curve. The combined analysis of the three curves offered valuable additional information, thus increasing the specificity of the findings. The study of pressure and flow curves, which are real-time curves covering the entire respiratory cycle, allowed us to confirm the on–off effect, that is, the appearance and disappearance of the changes concomitantly with the onset and end of stimulation. The patterns observed on capnography were of greater amplitude but rather nonspecific, whereas those observed on pressure and/or flow curve were generally of smaller amplitude but more specific, o","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"12 1","pages":"e15-e16"},"PeriodicalIF":0.7,"publicationDate":"2017-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1608623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35213645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Concept in Adult Peripheral Nerve and Brachial Plexus Surgery.","authors":"Lukas Rasulic","doi":"10.1055/s-0037-1606841","DOIUrl":"https://doi.org/10.1055/s-0037-1606841","url":null,"abstract":"<p><p>Peripheral nerve injuries and brachial plexus injuries are relatively frequent. Significance of these injuries lies in the fact that the majority of patients with these types of injuries constitute working population. Since these injuries may create disability, they present substantial socioeconomic problem nowadays. This article will present current state-of-the-art achievements of minimal invasive brachial plexus and peripheral nerve surgery. It is considered that the age of the patient, the mechanism of the injury, and the associated vascular and soft-tissue injuries are factors that primarily influence the extent of recovery of the injured nerve. The majority of patients are treated using classical open surgical approach. However, new minimally invasive open and endoscopic approaches are being developed in recent years-endoscopic carpal and cubital tunnel release, targeted minimally invasive approaches in brachial plexus surgery, endoscopic single-incision sural nerve harvesting, and there were even attempts to perform endoscopic brachial plexus surgery. The use of the commercially available nerve conduits for bridging short nerve gap has shown promising results. Multidisciplinary approach individually designed for every patient is of the utmost importance for the successful treatment of these injuries. In the future, integration of biology and nanotechnology may fabricate a new generation of nerve conduits that will allow nerve regeneration over longer nerve gaps and start new chapter in peripheral nerve surgery.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"12 1","pages":"e7-e14"},"PeriodicalIF":0.7,"publicationDate":"2017-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35466734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Useful Effects of Melatonin in Peripheral Nerve Injury and Development of the Nervous System.","authors":"Yigit Uyanikgil,&nbsp;Turker Cavusoglu,&nbsp;Kubilay Dogan Kılıc,&nbsp;Gurkan Yigitturk,&nbsp;Servet Celik,&nbsp;Richard Shane Tubbs,&nbsp;Mehmet Turgut","doi":"10.1055/s-0036-1597838","DOIUrl":"https://doi.org/10.1055/s-0036-1597838","url":null,"abstract":"Abstract This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an effective free radical scavenger and antioxidant. Since endogenous MLT levels fall significantly in senility, these findings imply that the loss of this antioxidant could contribute to the incidence or severity of some age-related neurodegenerative diseases. Considering the high efficacy of MLT in overcoming much of the injury not only to the peripheral nerve but also to other organs, clinical trials for this purpose should be seriously considered.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"12 1","pages":"e1-e6"},"PeriodicalIF":0.7,"publicationDate":"2017-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1597838","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35078744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal Scapular Artery Variations and Relationship to the Brachial Plexus, and a Related Thoracic Outlet Syndrome Case","authors":"Anne-Marie A Verenna, D. Alexandru, A. Karimi, Justin M. Brown, G. Bove, F. Daly, A. Pastore, Helen E. Pearson, M. Barbe","doi":"10.1055/s-0036-1583756","DOIUrl":"https://doi.org/10.1055/s-0036-1583756","url":null,"abstract":"Abstract Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"11 1","pages":"e21 - e28"},"PeriodicalIF":0.7,"publicationDate":"2016-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1583756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58154181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thiel Cadaveric Nerve Tissue: A Model for Microsurgical Simulation","authors":"A. Odobescu, Sami P Moubayed, M. Danino","doi":"10.1055/s-0036-1580626","DOIUrl":"https://doi.org/10.1055/s-0036-1580626","url":null,"abstract":"Peripheral nerve research as well as nerve repair simulation has relied heavily on the rat animal model, more specifically on the rat sciatic nerve.1 As the use of animals in experiments and training has received much criticism from animal rights activists and society at large, the field of surgical simulation is currently emerging. In microsurgery, high-fidelity Silastic models, animal parts such as chicken thighs or wings, and cadaveric specimens have been used. Based on the available experience with Thiel embalmed cadaveric tissue in simulation,2–4 we experimented with Thiel embalmed peripheral nerves for the purpose of microsurgical skill training. We used median, ulnar, and tibial nerves from cadavers that had been used for anatomic and surgical training and had not touched the peripheral nerve tissue. The donors had previously consented to tissue utilization in postmortem research. The tissues originated from cadavers prepared with the embalming method described by Thiel.5 This technique preserves texture, volume, color, and shape of the body as perfect as possible, with the advantage of avoiding decay observed with fresh cadaveric specimens. There is no shrinking or soaking of the soft tissues. Thirteen nerve sections measuring 5 cm eachwere prepared on a foam board. Needles (25 G) are used to fix the nerves to the foam board. A blue background was used for the exercise, as it improves contrast. An operating microscope (Opmi Pico, Carl Zeiss, Oberkochen, German) at 10 magnification was used for all microneurorrhaphies. Under magnification, the nerves were crushed in the midsection to simulate an injured nerve. The participants transected the nerve using a 15-blade scalpel, and trimmed the damagednerve tissue. The two endswere inspected for the fascicular architecture and oriented appropriately for the repair. The epineurium was then gently reflected back and the proud fascicles trimmed. Nylon 8–0 sutures were used to perform a simple epineural repair, starting with the 0and 180-degree orientation sutures and then filling in the required sutures to obtain a well-oriented microneurorrhaphy. Under magnification of the operative microscope, we found the Thiel nerve tissue to show a slight gray-brown discoloration with an epineural layer that was hydrophilic, giving the impression of edematous tissue (►Fig. 1). This thicker-than-normal epineural layer, however, offers adequate support for manipulation. Unfortunately, the cadaveric nature of themodel precludes the use of the vasa nervorum,which are not visible, for adequate orientation of the nerve. Upon transection of the nerve, it can be observed that the fascicles arewell preserved and bound byfirm endoneurium and perineurium which have not undergone the same edema as the epineurium (►Fig. 1). Despite therebeing no immediate herniation of nerve fascicles upon transection, the fascicles have a tendency to bemorehygroscopic, and by the end of the neurorrhaphy, one can observe some protrusion of","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"38 1","pages":"e18 - e20"},"PeriodicalIF":0.7,"publicationDate":"2016-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1580626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58134417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper Limb Multifactorial Movement Analysis in Brachial Plexus Birth Injury","authors":"J. Bahm","doi":"10.1055/s-0036-1579762","DOIUrl":"https://doi.org/10.1055/s-0036-1579762","url":null,"abstract":"Abstract Multifactorial motion analysis was first established for gait and then developed in the upper extremity. Recordings of infrared light reflecting sensitive passive markers in space, combined with surface eletromyographic recordings and/or transmitted forces, allow eclectic study of muscular coordination in the upper limb. Brachial plexus birth injury is responsible for various patterns of muscle weakness, imbalance, and/or simultaneous activation, soft tissue contractures, and bone-joint deformities, leading to individual motion patterns and adaptations, which we studied by means of motion analysis tools. We describe the technical development and examination setup to evaluate motion impairment and present first clinical results. Motion analysis is a reliable objective assessment tool allowing precise pre- and postoperative multimodal evaluation of upper limb function. Level of evidence: II.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"11 1","pages":"e1 - e9"},"PeriodicalIF":0.7,"publicationDate":"2016-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1579762","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58132370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury","authors":"J. Bahm","doi":"10.1055/s-0036-1579763","DOIUrl":"https://doi.org/10.1055/s-0036-1579763","url":null,"abstract":"Abstract In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"11 1","pages":"e10 - e17"},"PeriodicalIF":0.7,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1579763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58132380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal of Brachial Plexus and Peripheral Nerve Injury","authors":"Jörg Bahm","doi":"10.1055/s-0035-1570130","DOIUrl":"https://doi.org/10.1055/s-0035-1570130","url":null,"abstract":"I am grateful to Rolfe Birch who gave me the opportunity to participate as a board member in a journal dedicated to brachial plexus surgery, as this field concerns my daily clinical and scientific activities over the last ten years. Six months ago, I discovered the online Journal of Brachial Plexus and Peripheral Nerve Injury and was pleased by the idea of such a specific journal, providing open access and facilitating reaching colleagues all over the world, where our traditional and respected journals might not go. I also appreciate the technical opportunity, feasible within this journal, of publishing video documentation, as our operative results might be actually better expressed through this medium. I have to congratulate Dr Nath for his excellent initiative. I propose my input for this journal:-I expect that the journal will fulfill criteria of a scientifically honest, balanced and innovative platform for all interested colleagues;-I believe that an online journal with free access in all countries has large possibilities to share data, high quality photos and videos with critical readers-My goal is to join the Journal and uphold international scientific standards and basic rules when sharing high level medical and scientific expertise. I would like to encourage all colleagues to participate in the discussion by sharing their experience, comments, criticisms, starting with questions, observations, empiric conclusions and scientific contributions. The JBP&PNI started as an initiative to be an open-minded platform for an exchange of ideas and techniques in this particular field of clinics and surgery, brachial plexus pathology and related issues in severe peripheral nerve injuries. Colleagues from all countries who are involved in these treatment plans should feel free to communicate their experience and analysis of the existing literature. Senior colleagues should share their comments about trials and pitfalls, for the benefit of our continued education and thus better serve patients hit by severe nerve injuries, either children or adults. During the past 10 years, I have become aware of how many controversies might exist even between international colleagues sharing one particular medical problem, and this is for many reasons. I believe, however, that we should overcome these differences just by focusing on common, noble targets of scientific education, giving our very best, and respecting established rules that good medical practice has taught us. which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"10 1","pages":"e1 - e1"},"PeriodicalIF":0.7,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1570130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58121403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}