Case Series: Reconstructive Strategy in Brachial Plexus Injuries

Purpose

Brachial plexus reconstruction involves complex, highly individualised decision-making — nerve transfer selection, timing, and sequencing vary case to case. This series is presented as a structured basis for academic discussion rather than a definitive protocol.

Scope

The series covers cases spanning traction injuries and, less commonly, sharp or iatrogenic plexus injury, reviewed for:

• Injury level and pattern (upper, lower, or total plexus involvement), established through clinical exam, electrodiagnostic studies and MRI
• Timing of intervention, weighing the window for nerve transfer viability against the possibility of spontaneous recovery in partial injuries
• Reconstructive strategy chosen — nerve transfer, nerve grafting, or a combined approach — and the reasoning behind each choice
• Functional outcome, assessed at defined intervals using standardised motor and sensory grading

Discussion themes

Cases in this series are grouped around recurring decision points that are useful for trainees and referring clinicians to understand:

• How the timing window for nerve transfer is weighed against observed clinical recovery in upper trunk injuries
• Donor nerve selection trade-offs when multiple transfer options are viable
• How imaging findings (pseudomeningocele, root avulsion signs) shape the reconstructive plan versus relying on electrodiagnostics alone

A note on this format

We present this as a case series specifically because brachial plexus reconstruction resists simple protocolisation — the value is in seeing how a consistent decision-making framework gets applied across genuinely different presentations. Detailed case-level data is available to academic collaborators on request via the Contact page.