Avulsion injury – Nerve rupture – Brachial plexus
Avulsion injury is usually caused by traffic accidents or falls from a height, where nerve roots are severed at the point where they exit the spinal cord.
If a nerve is severed from its root, it no longer has the possibility of attaching to the root.
Therefore, to treat nerves severed at the root, it is necessary to create a nerve interconnection between the functioning nerves and a location far from the severed area. However, these interconnection nerves do not take hold immediately. Whether the nerve interconnection has taken hold becomes apparent within 1-2 years. If there is still no sign of improvement after 2 years, it means the interconnection has not taken hold.
When an avulsion injury occurs, it is important not to delay nerve attachment surgery, as the longer you wait, the less potential the nerves have to heal.
What is the brachial plexus? : After the cervical nerves exit the spinal cord, they intertwine in a network and then separate again, supplying different muscle groups of the arm and shoulder. The nerve network where this intertwining and separation takes place, located above and below the collarbone in the shoulder, is called the brachial plexus.
In traffic accidents, especially motorcycle accidents, brachial plexus injury occurs. The nerve roots forming the brachial plexus are severed from their exit points in the spinal cord due to severe stretching of the shoulder, resulting in avulsion injury.
Below, I have shown how we repaired a brachial plexus avulsion injury using the sural nerve taken from the left foot in one case.
Cervical MR myelography shows avulsion injury of the C8-T1 roots.
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To help understand the image above, I've colored the avulsion in the adjacent image.
The patient, about to undergo surgery, is lying on their back. The left shoulder is visible when viewed from the head. Accordingly, the left brachial plexus is shown on the shoulder.
I've shown the C8 and T1 nerve roots in black because they are severed.
The image shows an 11 cm long section of the sural nerve taken from the leg.
Since the sural nerve only carries sensory fibers, its removal will not cause loss of strength in the legs. There will only be a slight loss of sensation.
The image above, taken during the operation, is superimposed on the previously drawn diagram. The sural nerve is shown in the image below, painted over.
The sural nerve graft, placed between the C5 nerve root and the medial cord of the brachial plexus, is shown in green above. The sural nerve is routed over the clavicle and under the muscle.
The image shows the scar resulting from the removal of the sural nerve from the leg.