Report of the 1993–94 Sterling Bunnell Traveling Fellow

Abstract

One of the greatest pleasures in my life has been to represent the American Society for Surgery of the Hand as a Sterling Bunnell Traveling Fellow. I began planning my travels with a mission. My primary objective was to see and evaluate different centers' philosophies, strategies, and results of treatment of brachial plexus injuries. My additional objectives were to visit centers of excellence, where I could exchange ideas on peripheral nerve basic research, and to observe and contrast healthcare systems in other parts of the world with the changing system that we are seeing develop in the United States. I started my trip from California by going east. On arrival in Stockholm, which was founded in 1252 and is the home of the Blue Hall, a venue for the Nobel banquet each year, I visited Thomas Carlsted at Sodersjukhuset and at the Karolinska Institute. Dr. Carlsted has a deep interest in brachial plexus injuries and pursues this specialty in both his investigative and his clinical activities. His research is innovative in that he has successfully implanted avulsed ventral roots back into the spinal cord. Most of this work has been in monkeys; however, Dr. Carlsted has implanted avulsed nerve roots in five patients, including one with birth palsy, with some limited functional return. In an area once considered irreparable, there is now some hope of bridging the central and peripheral nervous system. In light of Sweden often being cited as having a model healthcare delivery system, we discussed some interesting social issues. In a population of 8 million, the government assigned all hand malpractice cases to be reviewed by three hand surgeons and all workers'