Brachial plexus root avulsions

The majority of adult brachial plexus palsies are posttraumatic injuries ca used by high-energy forces, usually involving motor vehicles. In infants, b rachial plexus palsies commonly represent obstetrical injuries following ex cessive traction on the plexus during complex or difficult delivery. Most a dult injuries, and occasionally those in infants, represent brachial plexus root avulsion injuries that carry serious ramifications from the standpoin t of permanent disability of a paralyzed extremity, prolonged recuperation, and significant socioeconomic impact. Modern-day management of root avulsi ons should focus on early, aggressive microsurgical reconstruction of the b rachial plexus, combining various neurotizations with intraplexus and extra plexus ipsilateral and contralateral nerve donors, utilization of vasculari zed nerve grafts, and finally the use of free vascularized and neurotized m uscles. When these multistage microsurgical management techniques are appli ed early (with complete avulsions) they may often result in significant ret urn of neurologic function, especially in young patients. Amputation should be looked upon as an option only when these newer microsurgery techniques have failed.