Surgery for Lesions of the Brachial Plexus

Common Misconceptions and Controversies Regarding Ballistics and Gunshot Wounds

“…44,84 Artificial simulants typically fail to take into account the presence of factors that can affect the wounding potential of the projectile, including skin, the size and shape of the limb, how tightly the tissues being subjected to stretch are bound to surrounding structures or enclosed by fascia, and the presence of clothing. 66,77,85,86 Simulants such as clay, 27,75 soap, 76,77,83,87,88 and gelatin 44,49,65,66,70,72,77,89,90 are isotropic and therefore also fail to take into consideration the heterogeneous nature of living tissues and their interactions (skin, fascia, bone, and visceral organs all have different material properties such as density, specific gravity, elasticity). Furthermore inelastic mediums, such as clay or soap are limited in that their configuration after passage of a projectile reflects the maximal temporary cavity diameter, which tends to overestimate the amount of damage caused in living tissue.…”

Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center

“…1,30,39,40,42,49 To date, favorable surgical outcomes have been reported in only approximately 60% of patients with plexus injuries. 2,3,26,29,41 Such outcomes need to be and can be improved. Especially difficult to evaluate and treat are patients with stretch/ avulsion and suspected TOS.…”

Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions

“…20 On the other hand, since there is great sensory innervation overlap to the index finger, middle finger, and even thumb, interpretation of SNAPs must be cautious in patients with C5, C6, C7 lesions, and especially those with C5, C6 lesions. 24 Assessment of patients with brachial plexus injuries should include careful review of cervical spine and chest radiographs. These may reveal associated fractures of the neck (such as transverse process fractures), clavicle, or ribs, or demonstrate an elevated hemidiaphragm-all findings which can be associated with proximal brachial plexus injury.…”