We reviewed, at two to seven years, the results of repair of 108 median and ulnar nerves after clean transection injury between the elbow and wrist in 95 patients ranging in age from 15 to 55 years. Of these, 48 nerves had primary suture, 25 had delayed suture, and 35 were grafted, all repairs being performed by the senior author using standard techniques. Assessment was based on the methods and grading described by Seddon (1975). Thirteen of 60 secondary repairs or grafts failed, but no primary repair failed completely. There were few excellent results; they were found only after primary distal repair in younger patients.

We describe a method for approaching the lower cervical and upper thoracic spine, the brachial plexus and related vessels. The method involves the elevation of the medial corner of the manubrium, the sternoclavicular joint, and the medial half of the clavicle on a pedicle of the sternomastoid muscle. We have used this exposure in 17 cases with few complications and good results. Its successful performance requires high standards of anaesthesia, surgical technique and postoperative care.

We report a hitherto undescribed type of peripheral nerve lesion in which pressure results in mechanical demyelinisation of a length of nerve with interruption of conduction. On release of the pressure, early recovery may follow the return of the myelin insulation.

We have reviewed 50 patients at a mean period of 2.7 years after operations to restore elbow flexion lost as a result of traction injuries of the brachial plexus. A variety of operations were used and, in general, patient satisfaction was high. Objectively, however, the power in the transferred muscles was poor; less than half of the patients had a significant improvement in function. Poor control of the shoulder often compromised the result. Latissimus dorsi and triceps transfers proved most reliable, and some Steindler flexorplasties also gave satisfactory results. Pectoralis major transfers were disappointing and we do not recommend their use in women.