Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial...

Area of Science:

• Neurosurgery
• Reconstructive Surgery
• Peripheral Nerve Injury

Background:

• Traditional contralateral C7 nerve transfer for brachial plexus avulsion often yields unsatisfactory results due to lengthy nerve grafts.
• Long nerve grafts in brachial plexus repair lead to prolonged regeneration times and irreversible muscle atrophy.
• A new surgical approach is presented to address these limitations in total brachial plexus avulsion.

Purpose of the Study:

• To evaluate the efficacy of a modified contralateral C7 nerve transfer technique.
• To restore finger and wrist flexion in patients with total brachial plexus avulsion.
• To assess functional recovery using a standardized grading system.

Main Methods:

• Seventy-five patients with total brachial plexus avulsion underwent contralateral C7 nerve transfer via a modified prespinal route.
• Direct coaptation with the injured lower trunk was achieved, with 35 patients requiring humeral shortening osteotomy.
• In 47 patients, the contralateral C7 nerve was also transferred to the musculocutaneous nerve.

Main Results:

• Mean follow-up was 57 months.
• Satisfactory motor function (M3+ or greater) was achieved in 60% for elbow flexion, 64% for finger flexion, 53% for thumb flexion, and 72% for wrist flexion.
• The technique demonstrated successful repair of both the lower trunk and musculocutaneous nerve targets.

Conclusions:

• The modified prespinal contralateral C7 nerve transfer significantly shortens the nerve regeneration pathway.
• This technique provides satisfactory recovery of finger and wrist flexion in total brachial plexus avulsion.
• The approach is versatile, enabling repair of multiple target nerves.