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October 11, 1976

Repair of Severed Brachial Plexus

Author Affiliations

Emory University Atlanta

JAMA. 1976;236(15):1692. doi:10.1001/jama.1976.03270160016011

To the Editor.—  The case report by Drs Amine and Sugar in "Repair of Severed Brachial Plexus: A Plea to Emergency Room Physicians" (235: 1039, 1976), while outlining some established principles for the acute care of nerve injuries, does not take into account any of the recent developments in the management of nerve gaps. Specifically, we refer to the work of Millesi et al1,2 and suggest interfascicular nerve grafting as an alternative approach in such cases.They refer to "extensive mobilization of distal nerves and 90° flexion of the elbow" to overcome a 9-cm gap. The deleterious effect of such extensive mobilization on the vascular supply of nerves has been demonstrated to by Smith.3,4 Millesi and co-workers have shown the superiority of results with an interfascicular graft as compared to direct epineural suture under tension.1,2 We believe that despite extensive mobilization, substantial tension must exist at the