Nerve Grafting. Millesi-H. Clinical Orthopaedics and Related Research. 1988 Dec. 237. pp 36-42. Brachial plexus lesions with complete or partial palsy of the dependent musculature are a severe handicap for the patient. By microsurgery of lesions in continuity and nerve grafting in cases with complete interruption, some recovery can be achieved. Comparing the present-day results with the ones of earlier years, a significant increase of the percentage of useful recoveries has been observed. The quality of the results of the two groups does not differ very much. The repair of a lesion at the brachial plexus level is only one part of the game. After regeneration is completed, further surgery has to be done to improve the functional results, using all available techniques of muscle or tendon transfers, arthrodesis, etc. Very often, by the transfer of the triceps muscle to the biceps tendon, elbow flexion can be improved in cases of simultaneous innervation of the two muscles. Transfer of the horizontal part of the trapezius muscle to the humerus provides some stability to the shoulder joint. The biceps function can be improved by transferring the tendon to a new insertion with a better direction. Arthrodesis of the *wrist* joint improves function of the entire forearm if active stabilization by *wrist* flexors or extensors does not return. In some cases, multiple arthrodesis of the finger joints and the interphalangeal joint of the thumb, along with tendon transfers of available muscles in the forearm, permits the reconstruction of a gripping function.
Other links:
Brachial Plexus Injuries from the Orthopaedic Care Textbook 
