"There are two major types of surgery to restore function to the brachial plexus. One is nerve grafting and the other is nerve transfers. A nerve graft is the idea that if a portion of a nerve is damaged so badly that the wires within the nerve, called axons, cannot grow back through that area of damage to make the way to the muscle to restore movement. That section of damaged nerve must then be removed and a new nerve must be put in its place, allowing a bridge across from the healthy segment before the injury to the healthy segment after the injury. A nerve graft is often taken from a sensory nerve somewhere else in the body that is less important. The sural nerve or a nerve that runs from behind the knee to the ankle, which provides sensation to the lateral aspect of the foot, is often used because more than 30 centimeters of this nerve are available to reconstruct a large nerve root in the neck. The second procedure is referred to as a nerve transfer. And a nerve transfer is the idea that you can take a nerve that is already working, cut it and suture its end to the nerve that is no longer working so that the axons from a different muscle grow to a new target. This is often used in an upper brachial plexus injury. The patient who has a functional hand but no ability to move the shoulder or biceps, can often be reconstructed entirely by nerve transfers. So a portions of the nerve going to the hand can be rerouted to the biceps. So closure of the hand and flexion of the wrist will cause the elbow to flex. Similarly, we can use the triceps nerve branches and redirect that into the axillary nerve to restore the deltoid and have shoulder function recover. And the third transfer for this is the spinal accessory nerve or the nerve that goes to shrugging the shoulder. A portion of this can be cut and transferred to the suprascapular nerve, which is the nerve that also assists in shoulder abduction and external rotation. That is, raising the arm up to the side or rotating the hand away from the abdomen."
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