Introductory Chapter: Treatment of Brachial Plexus Lesions - A New Transdisciplinary Approach

*Jörg Bahm*

## **1. Introduction**

A *discipline* is defined as a group of experts sharing the same body of knowledge. There are several medical and also surgical and other disciplines involved in peripheral nerve reconstruction, such as neuro-, plastic, orthopaedic or hand surgeons, physio- and occupational therapists, neuropathologists, and bio-engineers.

The neurosurgeon is considered an expert in surgical treatment of pathologies within the central and peripheral nervous system and has particular knowledge in nerve anatomy, the physiology of nerve de- and regeneration, direct nerve repair techniques, microsurgery.

The orthopedic surgeon has specialized in bones and joints static and dynamic corrections and functional surgery of the lower limb, whereas the plastic surgeon deals with soft tissue and microsurgery and performs muscle and tendon transfers as well as small vessel and nerve microsurgery—hand and peripheral nerve surgery.

These attributions are of course country/continent dependent.

Giving an image to possible interactions between disciplines, a *multidisciplinary* approach assembles several disciplines in parallel, like several fruits placed in a basket. The routine interaction is *interdisciplinary*, like fruit pieces in a fruit salad. A *transdisciplinary* approach raises totally new issues, like in the creation of a smoothie.

### **2. The concept of transdisciplinarity**

Already in 1970, Jean Piaget stated that " a child is not a small adult."

In 1996, the French-Romanian physicist Basarab Nicolescu published a "manifest" about transdisciplinarity, where he developed it as a strong concept, but open and tolerant, transgressing frontiers between disciplines. He cited quantic physics, where the quantum (M. Planck: discontinuity of energy) may be seen as a particle or wave. There is also the time–space indeterminism (Heisenberg) and thus different levels of reality. Facing complex issues, one observes multiplication of disciplines.

Stephane Lupasco, a French-Romanian philosopher, introduced the " **included third**": Extending the concept of " A and non A" known in *classic* physics with the addition of a third status (being neither A nor " non A") in *quantic* physics.

Transdisciplinary approaches are actually seen in **science**, like physics; in **medicine**, like for general practitioners [1], in psychiatry-psychoanalysis, for example, in the treatment of psychopathy [2], emergency care of polytraumatized [3], oncology [4], and geriatrics [5].

It has to be distinguished from **translational** medicine ("*from bench to bed*"). We also find it in **nursing**, overall in palliative care [6] and even **politics**—like in Bhutan, the concept of "gross national happiness."

## **3. Examples in reconstructive brachial plexus surgery**

1.*think beyond the nerve repair one to one*

Some target nerves are more important than others for functional recovery. In obstetric brachial plexus palsy, the re-innervation of the suprascapular nerve is mandatory for a dynamic rotational equilibrium of the glenohumeral joint, a condition allowing congruent development of the joint partners and preventing dysplasia [7]. Thus, in specific conditions, this nerve must be targeted separately by a good motor donor nerve, like the distal/caudal branch of the spinal accessory nerve [8].


## **Author details**

Jörg Bahm Division of Plexus Surgery, Department for Plastic, Hand and Burn Surgery, RWTH University Hospital, Aachen, Germany

\*Address all correspondence to: jorg.bahm@belgacom.net

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Introductory Chapter: Treatment of Brachial Plexus Lesions - A New Transdisciplinary Approach DOI: http://dx.doi.org/10.5772/intechopen.101547*

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