Long Term Analysis of 11 Consecutive Contralateral C7 to Lower Trunk Transfer via a Pre-spinal Approach in Adult Pan Brachial Plexus Injury Patients.

Background

Contralateral C7 (CC7) is an important donor nerve for reconstruction in global brachial plexus palsy. In 2013, Shu Feng Wang introduced the direct repair of lower trunk (LT) to CC7. The outcomes of hand recovery reported in the study was significantly better than the traditional techniques. We did a retrospective analysis of 11 consecutive adult patients who underwent reconstruction for pan-brachial plexus injury by repair of the CC7 to LT along with other extraplexal nerve transfers.

Methods

Patients were evaluated for motor recovery of flexion and extension at elbow, wrist and digits (Modified medical research council [MRC] grading). They were also evaluated for cortical plasticity and complications, if any.

Results

Eleven consecutive patients underwent CC7 to LT transfer during the study duration. The mean follow-up period was 85 ±11.39 months (range: 69-105 months). Two out of the eight patients with a CC7 transfer to MCN regained M4 elbow flexion, while one regained M3 function. The remaining five did not recover elbow flexion. Two patients who had an ICN to MCN transfer regained M4 elbow flexion. Four out of 11 patients regained >M3+ wrist and finger flexion. Out of the four patients with a CC7 to LT, none recovered any elbow extension. Out of the seven patients who underwent a phrenic to PDLT transfer, six regained M3+ elbow extension. Out of the seven patients with phrenic to PDLT transfer, none regained any wrist or finger extension.

Conclusions

Outcome in terms of composite motor recovery of hand is better that other reconstructive techniques but falls short of qualifying as a functionally useful hand. Elbow flexion recovery is inferior when compared to other extraplexal nerve transfers. Neuropathic pain is reduced. There is restoration of protective sensation in both ulnar and median nerve territory. Level of Evidence: Level IV (Therapeutic).