Introduction: In brachial plexus palsy patients the neurotization of the musculocutaneous nerve is one of the primary goals in the reconstruction of the injured plexus since the return of elbow flexion is of paramount importance.

Material nad Methods: During the last 4 years (March 1998 – March 2002) 51 adult patients with post – traumatic brachial plexus palsy were operated in our Clinic. The mean age was 24,5 years and the most common cause of the injury was the motorvehicle accident. Exploration of the brachial plexus was performed in 39 patients, while 12 were late cases, (>2 years) and only secondary procedures were done i.e. muscle transfer. The mean denervation time was 8 months (1 to 14 months). Seven patients had an extended infraclavicular lesion, while from the 32 supraclavicular lesions, 21 had the element of avulsion (4 global, 10 with four root avulsion and 7 with three roots avulsed). Neurotization of the musculocutaneous was performed in the majority of the cases via nerve grafts from intraplexus (C5, C8, C7). Extraplexus donors were utilized in 14 patients. In 7 patients, the phrenic was used alone or with intraplexus donors (5)., in 3 cases the accessory nerve, in one patient the accessory and cervical plexus motor branches and finally in 3 patients 3 intercostals were used.

Results: All the patients with intraplexus neurotization of the musculocutaneous nerve, but two, regained useful function of the biceps (M3+ to M4++). From the extraplexus neurotization the phrenic nerve as a conjunctant donor gave functional result, the cases used alone gave M3 and M3-, the accessory neurotization gave M3+ in combination with cervical motors and M3-, when it was used alone. The intercostal neurotizations gave M2+ and M3.

Conclusions: In brachial plexus paralysis, when the element of avulsion is present, the neurotization often is based in extraplexus donors. The return of biceps function is greater and faster when intraplexus donors are used. The extraplexus neurotization can give satisfactory results used in combinations.