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

Abstract Purpose The purpose of this study is to present our long term follow up outcome on the use of the contralateral C7 (CC7) transfer to reinnervate three recipient nerves in the patients with total brachial plexus avulsion injury (BPAI). Methods We retrospectively reviewed data from 13 patients with total BPAI. All of the 13 patients were confirmed with phrenic nerve and spinal accessary nerve total injury on the affected side. 5 patients were 20 years or younger and 8 were older than 20 years at the time of surgery. In 1st stage, the entire CC7 was harvested and was transferred to pedicled ulnar nerve and the suprascapular nerve with sural nerve grafted. It was performed less than 6 months after injury in 10 patients; 3 underwent the procedure more than 6 months but less than 12 months. The ulnar nerve was transferred to median nerve and biceps branch in the 2nd stage about 4 to 8 months after the 1st stage. Results The recovery rate was 84.62% (11/13) for shoulder abduction, 53.85% (7/13) for shoulder external rotation, 84.62% (11/13) for elbow flexion, 61.54% (8/13) for wrist and finger flexor and 53.85% (7/13) in median nerve area sensation. The recovery of median nerve in younger group was significantly better than the elder group (p < 0.05). Conclusions The use of CC7 transfer for simultaneous repair of suprascapular nerve, median nerve and biceps branch is an effective procedure in treating total BPAI. This technique may become an option for treatment of total BPAI combined with phrenic nerve and spinal accessary nerve injured case.