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| Surgical Procedures for Total Paralysis | |
| Surgery in brachial plexus injuries involves re-establishment of the connection between the central nervous system (brain and spinal cord) and the target muscles in the upper limb. A source of growing nerve fibers (a stump of a spinal nerve) is an essential pre-requisite for this purpose. The gap between this nerve end and the specific target nerves is bridged by placing nerve graft cables. These cables are derived from cutaneous nerves (those supplying sensation to the skin) from the legs. This procedure does not produce any deficit in the legs. The cables are stitched at each end using fine nylon threads under the operating microscope. The nerve grafts serve as pathways to direct the growth of the nerve fibers towards the target nerves. | |
| Nerve Transfer | |
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In the absence of available nerve stumps on the side of the spinal cord (root avulsions), functioning nerves from outside the brachial plexus have to be re-routed for restoration of specific movements of the upper limb. In the order of priority, these functions are: 1. Elbow flexion against gravity (biceps). 2. Shoulder abduction and external rotation (supraspinatus and infraspinatus). 3. Thoracobrachial pinch (pectoralis major). 4. Sensation in the hand and, if possible, some bending of the fingers (median nerve). Each spinal nerve (root of brachial plexus) can provide 15000 to 30000 growing fibers while the nerve transfers supply a total of 20000 growing nerve fibers. Hence, the nerve transfers have to be judiciously distributed to specific functions. Experience has shown that shoulder and elbow functions can be reliably restored using nerve transfers. Function in the hand rarely improves with the help of nerve transfers performed in the neck or the axilla. |
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