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

Terzis, Julia K.; Kokkalis, Zinon T.

doi:10.1097/prs.0b013e31819ba48a

Cited by 117 publications

(97 citation statements)

References 26 publications

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“…Major factors recognized as influencing the outcome of peripheral nerve repair are the degree of injury, the age of the patient, type of nerve, level of injury, and the timing of repair, the last of which is particularly related to our findings. Proximal injuries, such as brachial plexus injuries, show only very limited motor recovery for wrist and finger flexors and none for intrinsic muscles (5,49). Delay in surgery of over 6 months significantly reduces the extent of motor recovery, and it is considered clinically fruitless to expect motor recovery if an operation is delayed for more than a year (50).…”

Section: Discussionmentioning

confidence: 99%

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Eddie¹,

Ômura²,

Cobos³

et al. 2011

J. Clin. Invest.

209

239

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Although peripheral nerves can regenerate after injury, proximal nerve injury in humans results in minimal restoration of motor function. One possible explanation for this is that injury-induced axonal growth is too slow. Heat shock protein 27 (Hsp27) is a regeneration-associated protein that accelerates axonal growth in vitro. Here, we have shown that it can also do this in mice after peripheral nerve injury. While rapid motor and sensory recovery occurred in mice after a sciatic nerve crush injury, there was little return of motor function after sciatic nerve transection, because of the delay in motor axons reaching their target. This was not due to a failure of axonal growth, because injured motor axons eventually fully re-extended into muscles and sensory function returned; rather, it resulted from a lack of motor end plate reinnervation. Tg mice expressing high levels of Hsp27 demonstrated enhanced restoration of motor function after nerve transection/resuture by enabling motor synapse reinnervation, but only within 5 weeks of injury. In humans with peripheral nerve injuries, shorter wait times to decompression surgery led to improved functional recovery, and, while a return of sensation occurred in all patients, motor recovery was limited. Thus, absence of motor recovery after nerve damage may result from a failure of synapse reformation after prolonged denervation rather than a failure of axonal growth.

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Section: Discussionmentioning

confidence: 99%

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Eddie¹,

Ômura²,

Cobos³

et al. 2011

J. Clin. Invest.

209

239

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show abstract

“…31 Recently, successful neurotization using a branch of the radial nerve for the triceps muscle as donor was performed with very good results. 3,13,15,18,27 Finally, we reported a success rate of 78.6% with a novel method of axillary nerve reconstruction that uses the fascicle of the ulnar or median nerve.…”

mentioning

confidence: 99%

End-to-side neurorrhaphy in brachial plexus reconstruction

Haninec¹,

Mencl²,

Kaiser³

2013

JNS

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Object. Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy.Methods. From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window.Results. The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair.Conclusions. The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.

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“…4,14,27,30,31,32,35 One of the possible reasons for this discrepancy was a difference in technique between studies; some authors performed hemi-CC7 nerve transfer to reduce donor-side morbidity. 27,30,32 Another reason may be related to the use of a verbal patient response to assess symptoms of the donor limb, which may have underestimated the extent of nerve damage. Collins et al 7 evaluated patients after upper-extremity nerve injury, with 76% reporting cold intolerance, and most of these patients continued to have symptoms 5 years after injury.…”

Section: Discussionmentioning

confidence: 99%

“…For patients in Group 1 (n = 21), the duration of follow-up ranged from 6 months to 2 years, whereas patients in Group 2 (n = 20) all had more than 2 years of follow-up. Since many authors 4,14,22,27,30,32,38 have reported restoration of normal function in the donor limb within 6 months after CC7 nerve transfer surgery, only patients who had undergone surgery at least 6 months previously were included in the postoperative evaluation groups. Two years after surgery was regarded as the demarcation point between Group 1 and Group 2, because recovery of motor function is scarcely possible after this time point due to muscle fibrosis.…”

Section: Participantsmentioning

confidence: 99%

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

Yang

Hou

et al. 2016

JNS

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OBJECT Donor-side morbidity associated with contralateral C-7 (CC7) nerve transfer remains controversial. The purpose of this study was to evaluate functional deficits in the donor limb resulting from prespinal route CC7 nerve transfer. METHODS A total of 63 patients were included. Forty-one patients had undergone CC7 nerve transfer surgery at least 6 months previously and were assigned to one of 2 groups based on the duration of postoperative follow-up. Group 1 (n = 21) consisted of patients who had undergone surgery between 6 months and 2 years previously, and Group 2 (n = 20) consisted of patients who had undergone surgery more than 2 years previously. An additional 22 patients who underwent CC7 nerve transfer surgery later than those in Groups 1 and 2 were included as a control group (Group 3). Results of preoperative testing in these patients and postoperative testing in Groups 1 and 2 were compared. Testing included subjective assessments and objective examinations. An additional 3 patients had undergone surgery more than 6 months previously but had severe motor weakness and were therefore evaluated separately; these 3 patients were not included in any of the study groups. RESULTS The revised Short-Form McGill Pain Questionnaire (SF-MPQ-2) was the only subjective test that showed a significant difference between Group 3 and the other 2 groups, while no significant differences were found in objective sensory, motor, or dexterity outcomes. The interval from injury to surgery for patients with a normal SF-MPQ-2 score in Groups 1 and 2 was significantly less than for those with abnormal SF-MFQ-2 scores (2.4 ± 1.1 months vs 4.6 ± 2.9 months, p = 0.002). The 3 patients with obvious motor weakness showed a tendency to gradually recover. CONCLUSIONS Although some patients suffered from long-term sensory disturbances, resection of the C-7 nerve had little effect on the function of the donor limb. Shortening preoperative delay time can improve sensory recovery of the donor limb.

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

Cited by 117 publications

References 26 publications

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

End-to-side neurorrhaphy in brachial plexus reconstruction

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

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