Plexus surgery deals with the treatment of injuries to the brachial plexus, a complex network of nerves that supplies the upper limb. If this network is damaged by trauma, a strain injury or a lesion, this results in motor deficits, loss of sensation or complete paralysis. Surgical management therefore involves microsurgical reconstruction, exploration and surgical repair of damaged nerve fibers. Early surgical intervention is crucial, as peripheral nerves regenerate by only a few millimeters per day and long-term deficits must be prevented.
The fundamentals include a precise analysis of the damage, electrophysiological diagnostics and an assessment of whether reconstruction or a nerve transfer is necessary. In many cases, damaged tissue, such as a neuroma, must first be removed before a bypass can be created using nerve grafts. In this process, autologous nerves are often harvested from less critical areas to restore function in the brachial plexus region. Plastic surgery plays a major role here, as it provides reconstructive techniques based on anatomical precision and the finest microsurgery.
Neurosurgery is also involved, particularly when the injury is close to the spinal cord or there is a combination of central and peripheral damage. In specialist centers, surgical treatment is planned on an interdisciplinary basis to achieve the best possible functional outcome. The aim is always to enable the restoration of natural movement patterns and muscular function. In cases of complex plexus injuries, a combination of reconstruction, nerve transfers and secondary muscle transpositions may be required.
Microsurgical reconstruction of peripheral nerves in the brachial plexus region – a typical surgical scenario in plastic and peripheral nerve surgery.
Peripheral nerve and plexus surgery encompasses the surgical treatment of damage to nerves in the upper extremity, the shoulder girdle and the hand. This includes acute lesions following accidents, damage resulting from injury to the brachial plexus, or chronic compression syndromes. In nerve surgery, the first step is to determine whether the injury is an axonotmesis, neurotmesis or partial damage. Depending on the findings, surgical repair, nerve repositioning or nerve transfer is performed.
With the aid of microsurgery, even the finest nerve fibers can be reconstructed. In this process, the damaged nerve is anatomically precisely aligned so that regenerating nerve fibers can find their way back to the muscle. Electrophysiology helps to test conductivity and identify functional defects. The removal of neuromas and the bridging of long defects with grafts are also common surgical techniques.
Many patients come to the Clinic for Plastic Surgery when paralysis, numbness or functional deficits persist despite conservative treatment. In these cases, surgical treatment can lead to a significant improvement in quality of life. Complex procedures are particularly necessary in cases of severe lesions, involving the rerouting of healthy nerves from the lower or upper limb. Modern surgical techniques often enable significantly better regeneration than in the past.
Plastic surgery plays a central role in the reconstruction of peripheral nerves. Many of the reconstructive procedures for brachial plexus injuries are based on microsurgical techniques that have been developed and further perfected in plastic and aesthetic surgery. These include nerve transfers, bridging with autologous grafts, or the reconstruction of large defects following injuries. The aim is to restore nerve function so that muscle strength, sensation and mobility can return.
In cases of complex damage, surgical strategies are combined: reconstruction of damaged nerves, functional muscle transfers and secondary procedures to optimize mobility. In some cases, it is necessary to reroute healthy nerves close to the muscles to restore important basic functions. Techniques such as the contralateral C7 transfer are used here to replace lost functions. Plastic surgery relies on stable, anatomically precise surgical techniques to ensure long-term results.
Another area is the treatment of chronic pain that can occur following nerve injuries. Significant pain relief can often be achieved through the removal of the neuroma and appropriate reconstructive measures. Peripheral nerve surgery works closely with hand surgery, as many injuries affect not only nerves but also tendons, muscles and blood vessels. This enables comprehensive restoration of upper limb function.
Specialist clinics for plastic surgery work closely with neurosurgery, hand surgery and trauma medicine to provide optimal treatment for complex plexus injuries. This interdisciplinary care is necessary because injuries to the brachial plexus are often accompanied by vascular damage, muscle injuries or associated injuries to the upper limb. Such centers are equipped with microscopes, electrophysiological diagnostics and state-of-the-art surgical techniques. This enables even severe lesions to be reconstructed.
At the clinic, detailed examinations are first carried out: electrophysiology, ultrasound, MRI and clinical tests to assess the loss of function in the affected nerves. An individual treatment plan is then drawn up, comprising surgical reconstruction, nerve transfers or secondary procedures. The surgical procedures require microsurgical precision and experience, as every nerve and nerve fiber must be precisely aligned. The earlier the operation is performed, the better the chances of successful regeneration.
Intensive follow-up care is required after the procedures. Physiotherapy, electrostimulation and targeted exercise therapy support the regeneration of the nerve fibers. The Department of Plastic Surgery supports patients over several months or years, as complete nerve regeneration takes a long time. Long-term care ensures that functional improvements remain stable and that muscles are adequately innervated.
Hand surgery plays a crucial role in the treatment of plexus injuries and peripheral nerve damage. As the hand, forearm and shoulder are closely interconnected, many procedures must be planned in collaboration with specialists in plastic surgery. The nerves, muscles, tendons and vessels of the upper limb are functionally interdependent, which is why precise reconstruction is essential. The aim is always to restore grasping, holding and fine motor skills.
Nerve transfers are frequently performed surgically, in which healthy nerves are rerouted to take over functions lost due to a lesion. Hand surgery also utilizes tendon transfers to improve movement when certain muscles no longer receive reinnervation. The combination of these techniques often yields functional results that would not be possible without surgical intervention. Through microsurgical precision, damaged areas are reconstructed and functional deficits are minimized.
Intensive rehabilitation follows the operation. The focus here is on restoring sensory and motor control over the hand. Collaboration between plastic surgery, hand surgery and physiotherapy is fundamental to long-term success. Following consistent therapy, many patients achieve a high degree of functional ability and resilience in the affected limb.
In cases of complex nerve damage, interdisciplinary treatment is essential. The Department of Plastic Surgery works closely with neurosurgery, peripheral nerve and plexus surgery, and trauma centers. This network is particularly crucial in cases of severe plexus injuries, lesions following road traffic accidents, or complete loss of function. This enables the development of surgical strategies that combine reconstruction, nerve transfer and secondary procedures.
Specialized centers are equipped with microscopes, high-resolution imaging and electrophysiological methods to analyze the damaged nerves. If necessary, exploration, removal of the neuroma or bridging of long defects is carried out. Rare procedures such as reconstruction via contralateral C7 transfer or complex nerve transpositions are also performed here. These techniques enable the targeted restoration of lost functions.
Following surgical treatment, a rehabilitation plan is drawn up, tailored individually to the nerve lesion and the affected muscles. Nerve regeneration takes time, which is why long-term support is important. Sometimes, functional limitations need to be further optimized through muscle transfers or secondary procedures. The aim is always to regain as much natural mobility, sensation and strength as possible.
How do plexus injuries occur and what symptoms typically arise?
Plexus injuries often result from a strong impact – such as in road traffic accidents or falls – and affect the brachial plexus. In the process, peripheral nerves can be overstretched, torn or wrenched from the spine. Those affected often immediately feel paralysis or numbness in the arm. In severe cases, there is also pain or complete loss of function, which is why an early neurological and plexus surgical assessment is important.
When is surgical intervention in plexus surgery necessary?
Surgery is necessary if the nerve does not regenerate spontaneously or if there is a complete tear. Depending on the findings, the surgical team will decide whether nerve reconstruction, nerve transfer or a bypass is required. Surgery must be performed early, particularly in cases of neurotmesis or severe lesions – ideally within the first few months. Surgical treatment improves the chances of restoring function and sensation to the affected limb.
What role does plastic surgery play in the treatment of peripheral nerves?
Plastic surgery is central to the process, as it employs microsurgical techniques to precisely reconstruct injured nerve fibers. Specialist plastic surgery clinics often work in an interdisciplinary manner with neurosurgery and hand surgery. This enables complex plexus injuries, defects or neuromas to be treated optimally. The aim is to restore lost functions, such as movement or muscle strength, through nerve reconstruction or transfers.
How long does recovery take after plexus surgery?
The regeneration of peripheral nerves is a slow process, as nerve fibers regrow by only a few millimeters per day. Depending on the extent of the injury, functional recovery can take months or even years. Early rehabilitation with targeted exercises and electrical stimulation supports recovery. The course of recovery varies from person to person, but specialized peripheral nerve and plexus surgery increases the chances of the fullest possible recovery.
