### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hey Dr. Still years ago. Was hit by car and damaged my nerves in my left arm. The doctor. Says its an left bracular plexis.  They did a nerve replacement, by taking nerved out of my left and right leg. But i didnt see any imrovement. Is there another alternative that i can check out

### output:

Hi, thanks for asking from Chat Doctor. I can understand your concern. You had nerve grafting for brachial plexus years ago. As you mentioned there was no improvement. I will first tell you about nerve recovery and then mention other options. The best recovery and regeneration of damaged nerve occurs in first 6 months. After it slows down, and it almost stops after 12 months. The last cut-off is 18 months. The ideal time for nerve graft surgery is 3 to 6 months post-brachial plexus injury (blunt injury) and immediate exploration if cut injury. Now as many years have passed, nerve graft is not an option here. It is because muscles atrophy after years. Even if nerve regenerates, muscle will not respond. So nerve reconstructing surgeons have developed other alternatives- Free muscle and tendon transfer - Here muscle is rotated from its original site and re-implanted in upper limb to provide shoulder abduction. e.g. Gracilis muscle.- Vascular pedicle muscle graft - Here muscle is completely transferred to upper limb. Its vascular supply is anastomoses to limb artery and nerve to healthy nerve. - Joint fusion - Shoulder is fused in slight abduction and elbow in 90 degree flexions. Wrist and fingers are fused in mid-pronation, slight flexion. The problem is that the results are not that much good. Fine movements can not occur. Only gross movements can occur. You can discuss above options with surgeon. Hope it will help. If any doubts, do let me know. Thanks. Take care. Chat Doctor. 