Long-Term Functional Results of Contralateral C7 Transfer

Abstract

From 1986 to 1994, 82 patients with brachial plexus root avulsion were operated on using a contralateral C7 nerve-root transfer. Forty-four patients underwent a one-stage procedure in which the distal end of the ulnar nerve was anastomosed to the contralateral C7 root, and the other 38 underwent a two-stage procedure (first phase: C7 root --> ulnar nerve; second phase: ulnar nerve --> recipient nerve). Twenty postoperative cases were followed-up for 2 years. Of them, the ulnar nerve was transferred to the musculocutaneous nerve in six cases, with recovery of the biceps up to M3 in four and S3 in five cases; the ulnar nerve was transferred to the median nerve in eight cases, with recovery of the wrist and finger flexors up to M3 in five and S3 in six cases; the ulnar nerve was transferred to the radial nerve in four cases, with recovery of the triceps up to M4 in two and S3 in three cases; and the ulnar nerve was transferred to the thoracodorsal nerve in two cases, with recovery of the latissimus dorsi to M4 in one case. The total muscle recovery rate (up to M3) of the series was 60 percent, and the sensory recovery rate (S3) was 78 percent. Outcomes were related to patient age, operative delay, and whether or not the ulnar nerve was used as a bridge for transfer.

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 1): Transferencias nerviosas extraplexuales

“…Es por ello que se ha sugerido, en forma teórica inicialmente y luego ya en forma empírica, seccionar dicha raíz del lado sano para utilizarla como dador de axones al plexo paralizado. El primero en realizar esta técnica fue Gu en China 18,21 (Figura 12). El sacrificio de esta raíz implica una parálisis del trí-ceps muy leve, clínicamente no evidente, aunque se ha descrito, en casos muy esporádicos, un déficit de extensión de la muñeca 11,62 .…”

“…La ruta prefaríngea y el abordaje intradural disminuyen pero no eliminan este problema 38 . Las series más grandes empleando esta técnica han sido publicadas en Asia 11,18,60,67 . Los mejores resultados de forma global mostraron un 20% de éxito para reinervar la función motora del nervio mediano, mientras que los porcentajes publicados en cuanto a la recuperación sensitiva del mismo nervio fueron mejores, del 50% 18 .…”

Editorial. Myoelectric functional hand prosthesis for total brachial plexus injury

“…When the transfer recipient was the median nerve, patients reported reasonable wrist and finger flexion, with power ranging from Grade 2 to 3 on the British Medical Research Council (MRC) scale, in addition to protective sensation in the hand. 8 Doi and coworkers used a double free muscle transfer technique in highly selected patients after GBPI. These individuals were able to achieve some hand grasping, along with voluntary control of the shoulder and elbow.…”

Donor-side morbidity after contralateral C-7 nerve transfer: results at a minimum of 6 months after surgery

“…Thus, some authors have suggested that a long follow-up period is necessary to determine whether adequate function has been recovered. 13,33 In the study by Sammer et al, 27 it was not appropriate to report that the patient sustained "permanent" motor deficits on the donor side on the basis of follow-up evaluation performed 10 months postoperatively.…”