Timing of nerve surgery in brachial plexus injuries, how much early and how much late is acceptable for nerve surgery: a scoping review

Abstract

Brachial plexus injuries are complex and debilitating conditions that can significantly impair upper limb function in both pediatric and adult patients. Timely surgical intervention plays a crucial role in optimizing functional outcomes and promoting nerve regeneration. This review provides a comprehensive analysis of relevant literature, encompassing clinical studies, retrospective analyses, and meta-analyses, to assess the impact of early versus delayed surgical intervention on functional recovery, nerve regeneration, and long-term outcomes. In pediatric patients, early surgical intervention within the optimal window of opportunity is crucial for harnessing the remarkable regenerative potential of nascent nerve fibers and preventing the development of secondary complications. The review discusses the current evidence supporting early nerve exploration and reconstruction techniques in pediatric cases while highlighting the challenges associated with accurate diagnosis and the need for close multidisciplinary collaboration. At the same time, we have analyzed the relevant literature for guidelines in late-presenting cases. Conversely, in adult patients, the timing of brachial plexus surgery is often influenced by a myriad of factors, including the potential for spontaneous recovery, the presence of associated injuries, and the need for preoperative optimization. The review assesses the available evidence on the timing of surgery in adult cases, focusing on the delicate balance between early intervention to maximize nerve regeneration and functional recovery and the potential benefits of delayed surgical strategies. In conclusion, this comprehensive review consolidates the existing knowledge on the timing of brachial plexus surgery in pediatric and adult patients. It emphasizes the importance of a tailored, patient-centerd approach that considers various clinical factors to optimize surgical outcomes and improve functional recovery. The findings presented in this review provide valuable insights for clinicians and researchers, serving as a foundation for further studies aimed at refining surgical strategies for managing brachial plexus injuries.