Brachial Plexus Injuries are a catastrophic situation that affects patients on many levels. While many treatment options are discussed in the literature, general treatment principles should be applied, especially in the acute phase. In addition to the surgeon's expert knowledge of anatomy and injury characteristics, education of the patient concerning the ramifications of their injury and providing clear expectations of realistic outcomes are imperative for both the surgeon and the patient. A review of the principles of acute surgical treatment will be presented.