The determination of the end-to-side anastomosis within the neurotization techni ques in thebrachial plexus reconstruction and the influence of the locally appli ed VEGF on the peripheral nerve regeneration

There is rising importance of the brachial plexus injury firstly due to its increasing incidence as a result of higher survival rate of the patients after polytrauma and due to the higher success rate of the surgical treatment. Recently, the obstetric brachial plexus palsy is the area of interest of many articles. The indication criterion is one of the most important problems to be solved as well as increasing awareness about the possibility of the surgical treatment. Many of injured elements of the brachial plexus are reconstructed by a donor nerve transfered onto the recipient nerve, i.e. by neurotization. This method can have better outcome than the suturing of the proximal parts of the plexus especially due to its main advantage - suturing as close to the muscle as possible. It is still not clear which donor nerve is better to use for neurotization of specific recipients due to the lack of large randomized clinical trials. End-to-side anatomosis (ETS) was re-discovered at the beginning of 90's at the same time when the Oberlin method (OT) was firstly described in the literaure. These techniques are applicable only in the Erb's palsy with functional lower part of the plexus. The basis of the effect of ETS anastomosis is the collateral sprouting of the axons which is one of the most important..