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Abstract
Brachial plexus injury is regarded as one of the most devastating injuries of the upper extremity. Accurate diagnosis is important to obtain the successful results. Basic preoperative evaluation includes simple radiography, cervical myelography. Magnetic resonance imaging, angiography, electrophysiologic studies and intraoperative studies. Furthermore, proper timing of surgery, surgical indication, plan and sufficient understanding of patients about the prognosis are the key for the satisfactory outcomes. This article provides an overview of the evaluation, diagnosis, intraoperative monitoring, and proper surgical planning for the treatment of posttraumatic brachial plexus injuries.
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 | Fig. 1.The anatomy of the brachial plexus. USS, upper subscapular; TD, thoracodorsal; LSS, lowere subscapular; MBC, medial brachial cutaneous; MABC, medial antebrachial cutaneus. |
 | Fig. 2.Traction injury of the brachial plexus. (A) Preganglionic injury cannot be repaired, (B) postganglionic stretch injury shows different magnitudes, and (C) extraforaminal rupture can be repaired with surgery |
 | Fig. 3.Double approach of brachial plexus injury (superior clavicular and deltopectoral approach). |
 | Fig. 4.Electrophysiological evaluation during the surgery. (A) Intraoperative electro-physiologic monitoring of 55-year-old male with C8–T1 brachial plexus injury. (B) These lines means the preoperative and intraoperative base amplitude of C8-T1. SNS, sypathetic nerve stimultation. |
 | Fig. 5.Nerve transfer of a 19 years-old male with right C5–6 brachial plexus injury after motorcycle accident. (A) The patient showed complete motor deficit in active elbow flexion and shoulder abduction. (B) Magnetic resonance image showed C5–6 nerve injury. (C) The 3–4 Intercostal nerves transfer to the musculocutaneous nerveand spinal accessory nerve transfer to the suprascapular nerve were performed at 7 months after injury. (D) Muscle strengths of elbow flexion and shoulder abduction were recovered at 16 months after surgery. SA, spinal accessory nerve; SSC, superior subscapular nerve; IC, intercostal nerve; MC, musculocutaneous nerve. |
 | Fig. 6.Functioning muscle transfer of a 64-year-old male who had crushing injury to his right arm at 1 year before the surgery. (A) The patient showed complete loss of active elbow flexion and shoulder abduction. (B) Gracilis muscle with monitoring flap was harvested from his right thigh. (C) Flap indicated well survival of free muscle transfer. (D) The patients showed excellent recovery of elbow flexion at 6 months after surgery. |
Table 1.
Clinical signs of preganglionic injury and its implications
Table 2.
Root innervation and motor functions in the upper extremity (from Robert et al.7)
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