Contralateral C7 Nerve Transfer with Direct Coaptation to Restore Lower Trunk Function After Traumatic Brachial Plexus Avulsion Injuries: Surgical Technique.

INTRODUCTION

We describe a new technique for treating traumatic brachial plexus avulsion injury with a contralateral C7 nerve transfer with direct coaptation that shortens the time to muscle reinnervation.

STEP 1 EXPLORE THE INJURED BRACHIAL PLEXUS: Explore the brachial plexus carefully and confirm the nerve-root avulsion injuries from C7 to T1.

STEP 2 HARVEST THE CONTRALATERAL C7 NERVE: Dissect the divisions of the contralateral C7 nerve root, divide the nerve at the junction between the divisions and cords, and mobilize it proximally.

STEP 3 CREATE THE PRESPINAL ROUTE: Create the prespinal route to guide the contralateral C7 nerve to the injured side.

STEP 4 HUMERAL SHORTENING OSTEOTOMY: If the contralateral C7 nerve does not reach the injured lower trunk, perform a humeral shortening osteotomy, generally with <5 cm of shortening in adults.

STEP 5 NEURORRHAPHY: Suture one end of the sural nerve together with the medial antebrachial cutaneous nerve to the musculocutaneous nerve; anastomose the remainder of the contralateral C7 nerve directly with the lower trunk.

STEP 6 POSTOPERATIVE CARE: Use a prefabricated brace to hold the head in the neutral position and immobilize the injured limb for six weeks.

RESULTS

We evaluated the results of the technique in a study of seventy men and five women with a mean age (and standard deviation) of 28 ± 10 years (range, ten to fifty-three years).IndicationsContraindicationsPitfalls & Challenges.