A Classical and Contemporary History of Brachial Plexus Treatment

Introduction: Brachial plexus injuries (BPI) have long been among the most unique and complicated injuries a surgeon may treat. The complex separating, merging, and winding of the nerves and the surrounding supporting anatomy make it difficult for even the most experienced surgeons to locate different nerve roots and segments, much less treat the accompanying complex and varied neurological injuries. Just as filled with twists and turns is the history of the treatment of these brachial plexus injuries dating back to the days of Homer and Galen. This historical and contemporary review details major pioneers of the field and their considerable innovations which have propelled the field over time. The early history delves into historical texts, the depictions of the brachial plexus by Da Vinci, and the first scientific mentions by Smellie. The intermediate history not only goes into the work by Duchenne, Erb, and Klumpke but also explores the nerve grafting by Seddon, the microsurgical work of Millesi and Narakas, and the spectacular standard-bearing career of Alain Gilbert. The recent history begins with John “Jack” Laurent and his nerve reconstruction techniques at Texas Children’s Hospital followed by the history and benefits of nerve allografts, first developed by Susan Mackinnon, and their extensive use today. The piece includes the increasing popularity of distal nerve transfers with scientific highlights by many of the major players of today with a nod to the late Dr. Yang for all of her splendid contributions. The contemporary acceleration in the development of surgical techniques and novel treatments in the past thirty years deserves all the approbation presented. Although there is still a long way to go in eliminating brachial plexus injuries, there has never been a more encouraging time for patients and surgeons striving to fix these complex injuries.

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