Modified C-7 neurotization in the treatment of brachial plexus avulsion injury

Abstract

Object Contralateral C-7 transfer is often used in patients with brachial plexus avulsion injury. Traditionally, the contralateral C-7 root has only been transferred to a single nerve, such as the median or radial nerve. In this study, the authors aimed to evaluate the efficacy of contralateral C-7 transfer to 2 different recipient nerves in patients with brachial plexus avulsion injuries. Methods Between 2004 and 2008, 10 patients with brachial plexus root avulsions underwent nerve reconstruction using a modified C-7 neurotization technique. In this procedure, the contralateral C-7 root was transferred via vascularized ulnar nerve grafts to both the musculocutaneous nerve and the median nerve on the affected side. Results The strength of the biceps muscles increased to M3 or M4 in 6 patients and to M2 in 2 patients. The median nerve transfers led to regained motor function and strength of the wrist and finger flexors with improvement to M3 in 5 patients. Seven patients showed notable gains of sensory function (≥ S3). Conclusions Contralateral C-7 transfer to 2 different recipient nerves is a feasible and efficient approach in patients with brachial plexus avulsion injuries when the donor nerve is limited.