Hand Clin 21 (2005) ix–x
Preface
Brachial Plexus Injuries in Adults
Allen T. Bishop, MD Robert J. Spinner, MD
Guest Editors
The loss of upper extremity function following
a traumatic brachial plexus injury causes devas-
tating functional deficits that require complex
surgical reconstruction. Because of advances and
innovations in surgical techniques, it is now
possible to reliably restore elbow flexion and
shoulder stability, provided intervention is
prompt. Recently, innovations have provided
additional surgical reconstructive options that
can be expected to improve functional outcomes.
For example, methods are available that may, at
times, restore basic grasp function in patients with
lower plexus rupture or avulsion. Surgeons from
all disciplines must be cognizant of these new
possibilities and seek out additional training or
partnerships across specialty boundaries to pro-
vide the best possible care in these devastating
injuries. In many such reconstructive schemes,
nerve transfer from multiple intra- and extraplexal
donor nerves and microvascular transfer of func-
tioning free muscles to the paralyzed limb are
integral parts of the total reconstructive plan. The
complexity and rigor of these procedures for both
0749-0712/05/$ - see front matter Ó 2005 Elsevier Inc. All rights reserved.
doi:10.1016/j.hcl.2004.10.001
Alexander Y. Shin, MD
the reconstructive team and patient are substan-
tial. Successful outcomes require not only consid-
eration of the nature of the plexus injury
(including location, mechanism, and elapsed time
from injury) and presence of associated injuries
but also surgical expertise, practical operative-
time constraints, and ability to provide and attend
prolonged postoperative rehabilitation.
In this monograph, an international group of
experts has distilled the current state-of-the-art
in evaluation and management of brachial plexus
injury. The concept for the monograph arose
during a recent skills course held at the Mayo
Clinic under the sponsorship of the American
Society for Surgery of the Hand and endorsement
of the Congress of Neurological Surgeons. The
contributors are derived from that faculty and
were selected based on their experience, knowl-
edge, and innovative approach to the evaluation
and management of this difficult problem.
It is our hope that these efforts will help
clinicians caring for these unfortunate patients
and, perhaps most important, to enable
hand.theclinics.com
x PREFACE

appropriate evaluation and timely referral to cen- Robert J. Spinner, MD

ters with expertise in brachial plexus care. Further, Departments of Neurologic Surgery,
the experience of the authors should provide a Orthopedics, and Anatomy
means to allow surgeons to improve patient out- Mayo Clinic School of Medicine
comes, and allow clinical investigators to further 200 First Street, SW
refine and improve the current state of the art. Rochester, MN 55905, USA
E-mail address: spinner.robert@mayo.edu
Allen T. Bishop, MD
Division of Hand Surgery Alexander Y. Shin, MD
Department of Orthopedic Surgery Orthopedic Hand and Microvascular Surgery
Mayo Clinic Mayo Medical School
200 First Street, SW 200 First Street, SW
Rochester, MN 55905, USA Rochester, MN 55905, USA
E-mail address: bishop.allen@mayo.edu E-mail address: shin.alexander@mayo.edu