Brachial plexus reconstruction based on the new definition of level of injury

David Chwei Chin Chuang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

11 Scopus citations


Although brachial plexus reconstruction remains a challenge to microsurgeons, especially when attempting to reconstruct cases with total root avulsion, much improvement in results has been recently achieved by a better understanding of various new methods of reconstruction, such as nerve transfer, functioning free muscle transplantation and prolonged postoperative rehabilitation. To better understand these improved results, we classified our patients into four levels of injury: (1) preganglionic root; (2) postganglionic spinal nerve; (3) pre- and retro-clavicular; (4) infraclavicular brachial plexus injury. Nerve transfer, functioning free muscle transplantation or local muscle transfer are the only possible solutions for the level 1 injury. Nerve transfers include extraplexus, intraplexus, close-target and end-to-side neurotisation. Neurolysis, nerve repair, nerve grafts, C-loop vascularised ulnar nerve grafts, nerve transfer and functioning free muscle transplantation are options for levels 2, 3 and 4 injuries. Tendon transfer, functioning or functional muscle transfer, arthrodesis or orthotics can be used for late palliative reconstruction. Taken together, these options can make brachial plexus surgery a worthy pursuit and make a useless limb useful.

Original languageEnglish
Pages (from-to)23-29
Number of pages7
JournalInjury Extra
Issue number3 SUPPL.
StatePublished - 09 2008


  • Brachial plexus injury
  • Level of injury and reconstruction


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