An expert opinion study was designed to query five countries and six brachial plexus surgeons regarding the demographics, mechanisms of injury, evaluation, timing of surgery, reconstructive strategies and controversies in adult traumatic pan brachial plexus injuries. Variations in assessing outcomes, management of neuropathic pain and future considerations were elucidated. Clear differences in regional demographics, mechanisms of injury, patient evaluation and treatment strategies were identified. The role of phrenic nerve and contralateral C7 transfer, acute use of free functioning muscle transfers, root reimplantation and amputation/myoelectric prosthetic fitting were regional/surgeon dependent. Comparison of outcomes across regions requires an understanding of the regional nuances of patient demographics, injury mechanisms, preferred reconstructive strategies and how outcomes are measured. Future studies are required to allow accurate regional comparisons.
AdamsJEKircherMFSpinnerRJTorchiaMEBishopATShinAY. Complications and outcomes of functional free gracilis transfer in brachial plexus palsy. Acta Orthop Belg. 2009, 75: 8–13.
2.
BarrieKASteinmannSPShinAYSpinnerRJBishopAT. Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion. Neurosurg Focus. 2004, 16: E8.
3.
BertelliJAGhizoniMFSoldadoF. Patterns of brachial plexus stretch palsy in a prospective series of 565 surgically treated patients. J Hand Surg Am. 2017, 42: 443–6 e2.
4.
BirchR. Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus. J Hand Surg Eur. 2015, 40: 562–7.
CarlstedtTAnandPHallinRMisraPVNorenGSeferlisT. Spinal nerve root repair and reimplantation of avulsed ventral roots into the spinal cord after brachial plexus injury. J Neurosurg. 2000, 93(2 Suppl): 237–47.
7.
CarlstedtTAnandPHtutMMisraPSvenssonM. Restoration of hand function and so called ‘breathing arm’ after intraspinal repair of C5-T1 brachial plexus avulsion injury. Case report. Neurosurg Focus. 2004, 16: E7.
8.
Carlstedt T. New treatments for spinal root avlusion injury. Front Neurol. 2016, 7(135) (eCollections).
9.
ChimHKircherMFSpinnerRJBishopATShinAY. Free functioning gracilis transfer for traumatic brachial plexus injuries in children. J Hand Surg Am. 2014, 39: 1959–66.
10.
Collaborators GBDRFGlobal, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018, 392: 1923–94.
11.
DyCJPeacockKOlsenMARayWZBroganDM. Incidence of surgically treated brachial plexus injury in privately insured adults under 65 years of age in the USA. HSS J. 2020, 16(Suppl 2): 339–43.
12.
FloresLPSocolovskyM. Phrenic nerve transfer for reconstruction of elbow extension in severe brachial plexus injuries. J Reconstr Microsurg. 2016, 32: 546–50.
13.
GiuffreJLBishopATShinAY. Harvest of an entire gracilis muscle and tendon for use in functional muscle transfer: a novel technique. J Reconstr Microsurg. 2012, 28: 349–58.
14.
HtutMMisraVPAnandPBirchRCarlstedtT. Motor recovery and the breathing arm after brachial plexus surgical repairs, including re-implantation of avulsed spinal roots into the spinal cord. J Hand Surg Eur. 2007, 32: 170–8.
15.
KaySPWibergMThorntonDJ. Nerves are living structures whose injury requires urgent repair. J Plast Reconstr Aesthet Surg. 2010, 63: 1939–40.
16.
LiFWangSFLiPCXueYHZouJYLiWJ. Restoration of active pick-up function in patients with total brachial plexus avulsion injuries. J Hand Surg Eur. 2018, 43: 269–74.
17.
LinnS. The injury severity score—importance and uses. Ann Epidemiol. 1995, 5: 440–6.
18.
MaldonadoAAKircherMFSpinnerRJBishopATShinAY (2016a) Free functioning gracilis muscle transfer versus intercostal nerve transfer to musculocutaneous nerve for restoration of elbow flexion after traumatic adult brachial pan-plexus injury. Plast Reconstr Surg138: 483e–8e.
19.
MaldonadoAAKircherMFSpinnerRJBishopATShinAY (2017a) Free functioning gracilis muscle transfer with and without simultaneous intercostal nerve transfer to musculocutaneous nerve for restoration of elbow flexion after traumatic adult brachial pan-plexus injury. J Hand Surg Am42: 293 e1–7.
20.
MaldonadoAAKircherMFSpinnerRJBishopATShinAY (2016b) The role of elective amputation in patients with traumatic brachial plexus injury. J Plast Reconstr Aesthet Surg69: 311–7.
21.
MaldonadoAARomero-BrufauSKircherRNMSpinnerRJBishopATShinAY (2017b) Free functioning gracilis muscle transfer for elbow flexion reconstruction after traumatic adult brachial pan-plexus injury: where is the optimal distal tendon attachment for elbow flexion?Plast Reconstr Surg139: 128–36.
22.
Martin NoguerolTBarousseRGomez CabreraMSocolovskyMBencardinoJTLunaA. Functional MR Neurography in evaluation of peripheral nerve trauma and postsurgical assessment. Radiographics. 2019, 39: 427–46.
OberlinCBealDLeechavengvongsSSalonADaugeMCSarcyJJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am. 1994, 19: 232–7.
PondaagWvan DriestFYGroenJLMalessyMJA. Early nerve repair in traumatic brachial plexus injuries in adults: treatment algorithm and first experiences. J Neurosurg. 2018, 130: 172–8.
27.
SammerDMKircherMFBishopATSpinnerRJShinAY. Hemi-contralateral C7 transfer in traumatic brachial plexus injuries: outcomes and complications. J Bone Joint Surg Am. 2012, 94: 131–7.
28.
Shahgholi L, Bengtson KA, Bishop AT, Shin AY, Spinner RJ, Basford JR, Kaufman KR. A comparison of manual and quantitative elbow strength testing. Am J Phys Med Rehabil. 2012, 91: 856–62.
29.
SocolovskyMAntoniadisGLovaglioA, et al.A comparison of patients from Argentina and Germany to assess factors impacting brachial plexus and brain injury. J Brachial Plex Peripher Nerve Inj. 2019, 14: e39–e46.
30.
SocolovskyMdi MasiGBonillaGDominguez PaezMRoblaJCalvache CabreraC. The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis. Acta Neurochir (Wien). 2015, 157: 1077–86.
31.
TangJBGiddinsG. Why and how to report surgeons' levels of expertise. J Hand Surg Eur. 2016, 1: 365–6.
32.
WangSFLiPCXueYHLiFBergerAJBhatiaA. Direct repair of the lower trunk to residual nerve roots for restoration of finger flexion after total brachial plexus injury. J Hand Surg Am. 2021, 46: 423.e1–423.e8.
33.
WangSFLiPCXueYHYiuHWLiYCWangHH. Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion. J Bone Joint Surg Am. 2013, 95: 821–7.
34.
WangSFLiPCXueYHZouJYLiWJLiY. Direct coaptation of the phrenic nerve with the posterior division of the lower trunk to restore finger and elbow extension function in patients with total brachial plexus injuries. Neurosurgery. 2016, 78: 208–15.
35.
WangSFXueYH. Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion injuries: surgical technique. JBJS Essent Surg Tech. 2014, 4: e5.
