During discussion of different congresses of nerve surgery it is possible to find different answers for this question. Nowadays is clear that the nerve surgeons have been look for the best option to do the reconstruction of total brachial plexus injury. The consensus of the best technique yet did not describe. Some surgeons perform neurotizaton associated to reconstruction of brachial plexus with nerve grafts other just reconstruction of brachial plexus with nerve grafts when nerve roots are available. There is consensus that child recovery is better than adult even in cases of complete lesion of brachial plexus. The time of lesion, body mass index, origin of patient, surgical material and expertise of surgeon, smoking, and diabetes may influence the outcomes of this type of reconstruction. There's described also free muscle transfer for this type of lesion. All surgeons consider this injury a real challenge, or better, a nightmare.

I have been performed this sequences of procedures:

1-Neurotization of accessory-spinal nerve for supra scapular nerve.

2-Neurotization of phrenic nerve for musculocutaneous nerve.

3-When spine nerve roots are available- C5 for anterior division of upper trunk and C6 for posterior division of upper trunk.

4-Intecostobrachial or intercostal nerve for lateral cord of median nerve. (Recovery sensory function)

Let your opinion!