Is it necessary to use the entire root as a donor when transferring contralateral C<sub>7</sub>nerve to repair median nerve?

Gao, Ke; Lao, Jie; Guan, Wenjie; Hu, Jingjing

doi:10.4103/1673-5374.224376

Cited by 9 publications

(3 citation statements)

References 39 publications

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“…A retrospective study by Gao and Hu et al from 1999 to 2006 stated that the motor function recovery for the entire C7 group was significantly better than the partial C7 group but no differences in the recovery of sensory function between groups [7]. Along with the retrospective study, an in vivo study using rats of Gao et al in 2018 concluded that harvesting of the entire contralateral C7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer [8].…”

Section: Discussionmentioning

confidence: 99%

Contralateral cervical 7 as a potential donor in nerve transfer of adult brachial plexus injury especially in root avulsion case: A case report

Irsa Rahardjo,

Heri Suroto

2023

World J. Adv. Res. Rev.

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Introduction: Contralateral cervical 7 (CC7) nerve transfer can be used in the absence of neurotizer in the BPI total root avulsion case. CC7 nerve transfer was introduced by Gu et al. in 1986, and aimed to restore motor and sensory function in the hand. The purpose of this paper is to report BPI patients with nearly total root avulsion using CC7 nerve transfer to the median nerve. Case Presentation: A man suffered a motorcycle accident in March 2010. There was a complete loss of motor and sensory in the right upper limb. From the examination, it was obtained that the cervical root avulsion of C5-6, C7 postganglionic rupture and cervical root avulsion of C8-T1. In April of 2010 has been done root neurotization C4 to C5, C3 root neurotization was to the suprascapular nerve, neurotization of the phrenic nerve to C6, neurotization C7 to C6 with graft, and neurotization CC7 to median nerve with vascularized pedicle ulnar graft. An evaluation was made at the donor and recipient sites. From the first admission he had total motoric loss to the last evaluation for 5 years post operation of motoric in the recipient site showed range of motion (ROM) of elbow flexion recovered to M4 with ROM 135o, shoulder abduction reached M3 30 o, finger flexion recovered to M2, and hand sensation came up to S1. There was no morbidity on the donor site from the first evaluation. Conclusion: Therefore, CC7 can be a potential donor in nerve transfer of adult BPI root avulsion cases without causing morbidity in the donor site.

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Section: Discussionmentioning

confidence: 99%

Contralateral cervical 7 as a potential donor in nerve transfer of adult brachial plexus injury especially in root avulsion case: A case report

Irsa Rahardjo,

Heri Suroto

2023

World J. Adv. Res. Rev.

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“…However, donor nerves for total brachial plexus injuries are scarce. In 1991, Gu et al pioneered the innovative surgical procedure of cC7 transfer for treating total brachial plexus avulsion injury [ 10 ], which has since been widely adopted by many centers [ 8 , 19 , 20 , 22 ]. The cC7 nerve, with an average total axonal count of approximately 27,000, offers a plentiful source of nerve fiber from the unaffected side without causing permanent morbidity in the healthy limb [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Restoration of intrinsic hand function by superficial radial nerve: an anatomical study

Liang

Liu

et al. 2023

BMC Musculoskelet Disord

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Background The contralateral seventh cervical (cC7) nerve root transfer represents a cornerstone technique in treating total brachial plexus avulsion injury. Traditional cC7 procedures employ the entire ulnar nerve as a graft, which inevitably compromises its restorative capacity. Objective Our cadaveric study seeks to assess this innovative approach aimed at preserving the motor branch of the ulnar nerve (MBUN). This new method aims to enable future repair stages, using the superficial radial nerve (SRN) as a bridge connecting cC7 and MBUN. Methods We undertook a comprehensive dissection of ten adult cadavers, generously provided by the Department of Anatomy, Histology, and Embryology at Fudan University, China. It allowed us to evaluate the feasibility of our proposed technique. For this study, we harvested only the dorsal and superficial branches of the ulnar nerve, as well as the SRN, to establish connections between the cC7 nerve and recipient nerves (both the median nerve and MBUN). We meticulously dissected the SRN and the motor and sensory branches of the ulnar nerve. Measurements were made from the reverse point of the SRN to the wrist flexion crease and the coaptation point of the SRN and MBUN. Additionally, we traced the MBUN from distal to proximal ends, recording its maximum length. We also measured the diameters of the nerve branches and tallied the number of axons. Results Our modified approach proved technically viable in all examined limbs. The distances from the reverse point of the SRN to the wrist flexion crease were 8.24 ± 1.80 cm and to the coaptation point were 6.60 ± 1.75 cm. The maximum length of the MBUN was 7.62 ± 1.03 cm. The average axon diameters in the MBUN and the anterior and posterior branches of the SRN were 1.88 ± 0.42 mm、1.56 ± 0.38 mm、2.02 ± 0.41 mm,respectively. The corresponding mean numbers of axons were 1426.60 ± 331.39 and 721.50 ± 138.22, and 741.90 ± 171.34, respectively. Conclusion The SRN demonstrated the potential to be transferred to the MBUN without necessitating a nerve graft. A potential advantage of this modification is preserving the MBUN’s recovery potential.

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“…Biologically, some rat experiments also mirrored the finding. Gao et al have reported that electrophysiological examination including maximum amplitude, latency, and muscle tetanic contraction force showed no significant difference between transferring the entire CC7 to repair the median nerve alone and transferring the entire CC7 to two recipient nerves, which were all better than partial CC7 transferring [ 8 ]. Similar results can also be obtained in terms of counts of myelinated axons in the median nerve.…”

Section: Introductionmentioning

confidence: 99%

Why It Is Necessary to Use the Entire Root rather than Partial Root When Doing Contralateral C7 Nerve Transfer: Cortical Plasticity Also Matters besides the Amount of Nerve Fibers

et al. 2021

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Previous studies suggested that the mode of donor transection is a critical factor affecting the efficacy of the contralateral C7 (CC7) nerve transfer. Nevertheless, the mechanism underlying this phenomenon remains elusive. The aim of this study was to investigate the relationship between the division modes of the CC7 nerve and cortical functional reorganization of Sprague-Dawley rats. We hypothesized that different methods of CC7 nerve transection might induce differences in cortical functional reorganization, thus resulting in differences in surgery efficacy. BDNF, TNF-α/IL-6, and miR-132/134 were selected as indicators of cortical functional reorganization. No significant differences in all these indicators were noted between the entire group and the entire root+posterior division group ( P > 0.05 ). BDNF and miR-132/134 levels in the entire group and the entire root+posterior division group were significantly increased compared with their levels in the posterior group and the blank control group ( P < 0.001 ). In all groups, BDNF, TNF-α/IL-6, and miR-132/134 levels in both hemispheres initially increased and subsequently decreased until week 40. In conclusion, this study provided the evidence of dynamic changes in BDNF, TNF-α/IL-6, and miR-132/134 in the cortex of rats after CC7 nerve transfer using different transecting modes, demonstrating that different CC7 nerve divisions might result in different surgical effects through modulation of cortical reorganization.

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Is it necessary to use the entire root as a donor when transferring contralateral C₇nerve to repair median nerve?

Cited by 9 publications

References 39 publications

Contralateral cervical 7 as a potential donor in nerve transfer of adult brachial plexus injury especially in root avulsion case: A case report

Contralateral cervical 7 as a potential donor in nerve transfer of adult brachial plexus injury especially in root avulsion case: A case report

Restoration of intrinsic hand function by superficial radial nerve: an anatomical study

Why It Is Necessary to Use the Entire Root rather than Partial Root When Doing Contralateral C7 Nerve Transfer: Cortical Plasticity Also Matters besides the Amount of Nerve Fibers

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Is it necessary to use the entire root as a donor when transferring contralateral C7nerve to repair median nerve?

Cited by 9 publications

References 39 publications

Contralateral cervical 7 as a potential donor in nerve transfer of adult brachial plexus injury especially in root avulsion case: A case report

Contralateral cervical 7 as a potential donor in nerve transfer of adult brachial plexus injury especially in root avulsion case: A case report

Restoration of intrinsic hand function by superficial radial nerve: an anatomical study

Why It Is Necessary to Use the Entire Root rather than Partial Root When Doing Contralateral C7 Nerve Transfer: Cortical Plasticity Also Matters besides the Amount of Nerve Fibers

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Is it necessary to use the entire root as a donor when transferring contralateral C₇nerve to repair median nerve?