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Selective Contralateral C7 Transfer in Posttraumatic Brachial Plexus Injuries: A Report of 56 Cases

Terzis, Julia K. M.D., Ph.D.; Kokkalis, Zinon T. M.D.

Plastic and Reconstructive Surgery: March 2009 - Volume 123 - Issue 3 - p 927-938
doi: 10.1097/PRS.0b013e31819ba48a
Hand/Peripheral Nerve: Original Articles

Background: Large experience in Asia has shown that the contralateral C7 nerve transfer has proved one of the major treatments for brachial plexus root avulsions. The authors report their experience in North America using the selective contralateral C7 transfer for neurotization of multiple targets.

Methods: A retrospective review of 56 patients with posttraumatic root avulsion brachial plexus injuries who underwent contralateral C7 transfer using selective technique was conducted. The targets included the axillary, musculocutaneous, radial, and median nerves. Additionally, neurotization of future free muscle transplantation was performed. The mean follow-up period was 6.1 years (range, 2.5 to 14 years).

Results: Motor recovery reached a level of M3+ or greater in 20 percent (two of 10) of patients for the deltoid, 52 percent (12 of 23) for the biceps, 24 percent (five of 21) for the triceps, 34 percent (10 of 29) for the wrist and finger flexors, and 20 percent (two of 10) for the wrist and finger extensors. In addition, sensory recovery of S2 or greater was achieved in 76 percent (22 of 29) of patients with median nerve neurotization. As far as the postoperative morbidity of the donor limb, by 6 months, there was no discernible motor or sensory deficit. Patients with a surgical delay of 9 months or less and patients aged 18 years or younger achieved significantly better results.

Conclusions: Brachial plexus root avulsions, long considered to be irreparable, are by no means unreconstructable. The selective contralateral C7 transfer appears to be a safe procedure, and it can be successfully applied for simultaneous reconstruction of several different nerves and/or for neurotization of future free muscle transfers.

Norfolk, Va.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Microsurgery Program, Eastern Virginia Medical School.

Received for publication May 2, 2008; accepted July 21, 2008.

Disclosure:No declared financial interests for either author in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Julia K. Terzis, M.D., Ph.D., Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, 700 Olney Road, LH 2055, Norfolk, Va. 23501, mrc@jkterzis.com

©2009American Society of Plastic Surgeons