Recent Trends in Primary Brachial Plexus Surgery

Abstract

The outcome of brachial plexus surgery depends on the timing of surgery and also the surgical techniques being used. There has been much recent advancement in the surgical management of these injuries. A lot of work has been directed towards improvising on the microsurgical technique like interfascicular neurolysis and use of tissue glue. Also newer adjuncts to surgery like the use of nerve conduits have eased the surgery. Distal nerve transfers have been shown to have shorter re-innervation recovery time and used at sites other than infra and supra-clavicular fossa. Spinal nerve root implantation has also come a long way in patients with cervical nerve root avulsion. Endoscopic exploration and the robotic surgery has brought in a revolution in the microsurgical field and brachial plexus surgery is not an exclusion. Several animal and human cadaveric studies have been performed to prove the feasibility of these techniques and proven with few case illustrations. And lately we are heading towards the use of robotic arm prosthesis in a case of missile induced nerve injuries. Neural machine interface is produced which supersedes the functional restoration provided by the conventional techniques.