Contralateral C7 nerve transfer to three recipient nerves-An optional surgical method in total brachial plexus avulsion combined with accessory and phrenic nerve injury.

Abstract

The purpose of this study is to present our long-term follow-up outcomes on the use of the contralateral C7 (CC7) transfer to reinnervate three recipient nerves in patients with total brachial plexus avulsion (BPA). We retrospectively reviewed data from 13 patients with total BPA. All patients were diagnosed with phrenic and accessory nerve injury on the affected side. Five patients were 20 years or younger, and eight patients were older than 20 years at the time of surgery. In the first stage, the entire CC7 was harvested and transferred to the pedicled ulnar nerve and the suprascapular nerve with a sural nerve graft. The ulnar nerve was transferred to the median nerve and biceps branch in the second stage about 4 to 8 months after the first stage. The British Medical Research Council (MRC) grading system was used for motor and sensory assessment. Of the 13 cases, 11 obtained equal or more M3 of shoulder abduction strength, and the effective rate of recovery was 84.62%. The effective rates were 53.85% (7/13) for shoulder external rotation, 84.62% (11/13) for elbow flexion, 61.54% (8/13) for wrist and finger flexion, and 53.85% (7/13) in median nerve area sensation. The recovery of median nerve function in the younger age group was significantly better than in the older group (p < 0.05). The use of CC7 transfer for simultaneous repair of the suprascapular nerve, median nerve, and biceps branch may become an option for the treatment of total BPA combined with phrenic nerve and spinal accessory nerve injuries.