This 30-year retrospective from LSUHSC analyzes surgical outcomes in 1019 brachial plexus lesions across five injury categories. It asks which injury patterns, intraoperative findings, and repair strategies predict functional recovery. With 42-month mean follow-up, it remains the largest single-institution series guiding brachial plexus surgical decision-making.
The intraoperative NAP is the single most important decision point in brachial plexus surgery, and this series of 1019 cases is the evidence base behind that principle. Before NAP recording was routinely used, surgeons were resecting or bypassing lesions in continuity that were actively regenerating — a practice this data definitively overturned.
When you explore a brachial plexus injury and find a lesion in continuity, stimulate and record before you cut anything. A recordable NAP means neurolysis only, regardless of how the nerve looks. A flat trace means resect back to healthy fascicles and reconstruct with sural graft.
When you see a sharp laceration, get the patient to the OR within 72 hours for primary epineurial suture. That window is the difference between 81% and 53% recovery. For blunt injuries, delay intentionally: the zone of injury declares itself over days to weeks, and premature repair wastes healthy graft on unhealthy stumps.
Counsel C5-T1 flail arm patients early and honestly. With only 35% achieving Grade 3+ overall and almost no useful distal hand function, the goal of surgery is proximal recovery. Shoulder abduction and elbow flexion, not hand restoration.
This 30-year retrospective from LSUHSC analyzes surgical outcomes in 1019 brachial plexus lesions across five injury categories. It asks which injury patterns, intraoperative findings, and repair strategies predict functional recovery. With 42-month mean follow-up, it remains the largest single-institution series guiding brachial plexus surgical decision-making.
The intraoperative NAP is the single most important decision point in brachial plexus surgery, and this series of 1019 cases is the evidence base behind that principle. Before NAP recording was routinely used, surgeons were resecting or bypassing lesions in continuity that were actively regenerating — a practice this data definitively overturned.
When you explore a brachial plexus injury and find a lesion in continuity, stimulate and record before you cut anything. A recordable NAP means neurolysis only, regardless of how the nerve looks. A flat trace means resect back to healthy fascicles and reconstruct with sural graft.
When you see a sharp laceration, get the patient to the OR within 72 hours for primary epineurial suture. That window is the difference between 81% and 53% recovery. For blunt injuries, delay intentionally: the zone of injury declares itself over days to weeks, and premature repair wastes healthy graft on unhealthy stumps.
Counsel C5-T1 flail arm patients early and honestly. With only 35% achieving Grade 3+ overall and almost no useful distal hand function, the goal of surgery is proximal recovery. Shoulder abduction and elbow flexion, not hand restoration.