Historical aspects treatment in patients with brachial plexus traumatic injury

Abstract

The aim of this review is to organize the evolution of the knowledge about the traumatic injuries of the brachial plexus, which provoke great sequels whose prevalence has been increased by the increase of urban violence, in particular, with reference to traffic accidents by motorcycles. A historical review of these lesions has been carried out, from antiquity to the present, when important paradigm shifts are occurring in diagnosis and in conducts. In the beginning, there was practically no treatment (X century BCE until X.C.), but with the evolution of surgical techniques and Cartesian thinking of restoration of anatomy and function, neurorefias of the open plexus lesions occurred in war injuries. Another decisive moment was the advent of anesthesia in the 19th century, which allowed surgical intervention of the plexus for longer periods, both in open and closed lesions, from which new surgical techniques were proposed. Another important change occurred in the twentieth century, with the objective of restoring the injured limb function through surgeries in other limb regions, in addition to plexus intervention. A major breakthrough was the emergence of myotendotal transfers, initially local, and later the transplants provided by microsurgery. Currently the ducts are evolving in the aspects of rehabilitation, with earlier procedures that result in a better recovery, but what would really change the current reality would be an effective prevention of traffic accidents. The future bifurcates into two strands: the first, through neurorregeneration, use of stem cells, neural growth factors and neuroplasticity; the second by robotics that allows the construction of exoskeletons, implants of chips in the central nervous system for peripheral control and the replacement of the limb by artificial arms.