Repair of brachial plexus lesions by end-to-side side-to-side grafting neurorrhaphy: experience based on 11 cases

Eleven brachial plexus lesions were repaired using end-to-side side-to-side grafting neurorrhaphy in root ruptures, in phrenic and spinal accessory nerve neurotizations, in contralateral C7 neurotization, and in neurotization using intact interplexus roots or cords. The main aim was to approximate donor and recipient nerves and promote regeneration through them. Another indication was to augment the recipient nerve, when it had been neurotized or grafted to donors of dubious integrity, when it was not completely denervated, when it had been neurotized to a nerve with a suboptimal number of fibers, when it had been neurotized to distant donors delaying its regeneration, and when it had been neurotized to a donor supplying many recipients. In interplexus neurotization, the main indication was to preserve the integrity of the interplexus donors, as they were not sacrificeable. The principles of end-to-side neurorrhaphy were followed. The epineurium was removed. Axonal sprouting was induced by longitudinally slitting and partially transecting the donor and recipient nerves, by increasing the contact area between both of them and the nerve grafts, and by embedding the grafts into the split predegenerated injured nerve segments. Agonistic donors were used for root ruptures and for phrenic and spinal accessory neurotization, but not for contralateral C7 or interplexus neurotization. Single-donor single-recipient neurotization was successfully followed in phrenic neurotization of the suprascapular (3 cases) and axillary (1 case) nerves, spinal accessory neurotization of the suprascapular nerve (1 case), and dorsal part of contralateral C7 neurotization of the axillary nerve (2 cases). Apart from this, recipient augmentation necessitated many donor to single-recipient neurotizations. This was successfully performed using phrenic-interplexus root to suprascapular transfers (2 cases), phrenic-contralateral C7 to suprascapular transfer (1 case), and spinal accessory-interplexus root to musculocutaneous transfer (1 case). Both recipient augmentation and increasing the contact area between grafts and recipients necessitated single or multiple donor to many recipient neurotizations. This was applied in root ruptures (3 cases), with results comparable to those obtained in classical nerve-grafting techniques. It was also applied in ventral C7 transfer to the lateral or medial cords (3 cases) with functional recovery occurring in the biceps and pronator teres muscles, but not in dorsal C7 transfer to the axillary and radial nerves (3 cases) with functional recovery occurring in the deltoid and triceps muscles, and in whole C7 transfer to C5, 6, 7, 8T1 roots with functional recovery occurring in the deltoid (M4), biceps (M4), pronator teres (M4), and triceps (M3) (3 cases), and less so in the flexor carpi ulnaris and FDP (M3) (1 case) and the extensor digitorum longus (M3) (1 case). Contralateral C7 transfer to the lateral and posterior cords (4 cases) was followed by cocontractions that took 1 year to improve and that involved the rotator cuff, deltoid, biceps, and pronator teres (all agonists). Functional recovery in the triceps muscle was less than in the above muscles. Contralateral C7 transfer to C5-7 (1 case) was followed by cocontractions that took 1 year to resolve and that occurred between the deltoid, biceps, and flexor digitorum profundus. Interplexus root neurotization was done only in conjunction with other neurotization techniques, and so its role is difficult to judge. Though the same applies to regenerated lateral cord transfer to the posterior cord (2 cases), the successful results obtained from medial cord neurotization to the axillary, musculocutaneous, and radial nerves (1 case), and from ulnar and median nerve neurotization to the radial nerve (1 case), show that neurotization at the interplexus cord level may play a role in brachial plexus regeneration and may even be used to neurotize nerves and muscles distal to the elbow. The timing of repair was within 6 months after injury, except for 2 cases. In the first case, contralateral C7 transfer was successfully performed more than 1 year after injury. The second case was an obstetric palsy operated upon at age 8. Deterioration in motor power of the donor muscles that improved in 6 months was observed in 2 cases of interplexus neurotization at the cord level, because of looping the sural nerve grafts tightly around the donor nerves. Deterioration in donor-muscle motor power as a consequence of end-to-side neurorrhaphy was noted in the obstetric palsy case, when the flexor carpi radialis (donor) became grade 3 instead of grade 4. This was associated with cocontractions between it and the extensors. It took nearly 1 year to improve.     

肌电图-神经电图测定健侧颈_7神经根移位桥接至受体神经后再生的临床研究

目的　用肌电图 -神经电图检测方法 ,研究健侧颈 7神经根移位通过桥接至受体神经后再生的状况。方法　 1996年 3月至 1998年 9月 ,对 2 8例健侧颈 7移位二期手术后患者 ,定期进行肌电图 -神经电图随访。术后随访时间为 3～ 5 8个月 ,平均 15 .4个月。分别在胸锁关节、胸腋部、腋部、肘部或外侧肌间隔刺激受体神经 (肌皮神经、桡神经和正中神经 ) ,于该神经支配的相应肌肉上记录复合肌肉动作电位 (CMAP) ,测定其潜伏期 (L at)、波幅 (Amp)。计算出动力神经纤维在受体神经的运动传导速度(MNCV) ,并观察其肌电图表现。结果　患侧桡、肌皮和正中神经支配的相应肌肉 ,分别在术后 4、6和 12个月时检测到神经再生电位。结论　健侧颈7神经根移位后 ,受体神经中出现再生电位最早的为肌皮神经 ,桡神经次之 ,正中神经最晚     

大鼠改良颈7移位术的电生理研究

目的观察改良颈7移位术修复二组受损神经的电生理变化.方法建立大鼠颈7改良移位术模型（同侧颈7神经根后股,经同侧尺神经作为桥接神经分为两股与肌皮神经和正中神经内侧头缝合）,并与传统单组移位组进行神经电生理测定和比较.结果移位神经的各项电生理指标显示：术后早期（2～6周）,颈7二组神经移位组神经再生劣于同时间段单组移位组.随观察时间的延长,术后8周起,二组神经移位组肌电动作电位潜伏期及最大诱发电位波幅指标逐渐接近单组移位组和正常对照组,至12周上述指标与各组差异无统计学意义（P＞0.05）.结论大鼠改良颈7移位术电生理变化和传统单组移位术相近,说明颈7具有良好的再生潜力,可同时支配两组受损神经.     

多组神经束支部移位治疗臂丛神经上干损伤的近期疗效

目的 通过在各受区神经近入肌点处同时进行多组神经束支部移位,恢复臂丛神经上干损伤后丧失的肩肘功能.方法 2007年2月-9月,收治4例单纯臂丛神经上干损伤男性患者.年龄21～39岁.均为车祸伤.左侧1例,右侧3例.患侧肩关节外展、外旋、上举及屈肘不能;耸肩、伸肘、屈伸腕指肌力≥4级.肌电图检查:副神经、尺神经及肱三头肌长头肌支功能好;正中神经功能轻度受损.患者于伤后3～11个月入院.于全麻下行后路副神经到肩胛上神经、肱三头肌肌支到腋神经、尺神经部分束支到肱二头肌肌支和/或正中神经部分束支到肱肌肌支移位术.结果 术后切口均Ⅰ期愈合,其中1例术后出现手部尺侧麻木症状,经对症处理后症状消失.余患者未出现与供区神经相关的运动、感觉功能受损症状.4例均获随访,随访时间7～12个月.术后3～4个月患侧均出现肩外展、屈肘动作.肌电图显示3组受区肌肉均可记录到新生电位.术后6～7个月,患者肩外展30～65°,屈肘90～120°,肌力3～4级.1例随访12个月患者肩外展、上举、外旋及届肘主动活动度基本正常,三角肌、肱二头肌外形轮廓接近正常.结论 应用功能相近的供体神经进行多组神经束支部移位具有供区损失小、恢复时间快、功能恢复佳等优点.尤其适合因伤后时间长延误治疗及锁骨上探查有风险的臂丛神经上干损伤患者.     

神经束移位治疗臂丛神经根性撕脱伤70例临床报告

目的 观察应用神经束移位治疗臂丛神经根性撕脱伤的效果。方法 对７０例患者,于上臂上中部切取正中神经、心神经、胸背神经及健侧Ｃ７神经束移位给肱二头肌肌支、三角肌肌支等,重建肩、肘关节的功能。结果 供区部分神经切取后对肢体功能无明显影响。正中神经、尺神经部分束文、胸背神经、健侧Ｃ７束支移位比全干移位对肌功能的影响小,且同样有效。结论 肱二头肌肌支、三角肌肌支的神经纤维数量少,用供体神经部分神经束即可提供充足的神经纤维,且能保证移位的神经纤维能良好地长入肱二头肌和三角肌。     

Treatment of brachial plexus injury with modified contralateral C7 transfer

Objective: To study the curative effects of different surgical methods using a contralateral C₇ transfer technique for treatment of brachial plexus injury induced by root avulsion. Methods: Sixty‐four patients with brachial plexus injury due to root avulsion were divided into two groups: 30 patients were included in Group A and 34 in Group B. In Group A, the contralateral C₇ roots were partially transected and anastomosed to one end of an ulnar nerve graft which had been removed from the affected limb. The other end of the ulnar nerve was divided into two parts and anastomosed to the distal ends of the recipient median and radial nerves, respectively. In Group B, the whole of the contralateral C₇ roots was transected and anastomosed to one side of an ulnar nerve graft, the other side of which was anastomosed eight months later to the distal ends of the recipient median and radial nerves. All subjects were followed up and the outcomes assessed. Results: Neurological deficit and recovery time of the donor limb in group A were less than those in group B. The nerve transfer procedure to the affected limb was easily completed in group A with less morbidity, and the tension of the stoma in group A was less than that in group B. However, there was no statistical difference between group A and B in the recovery of motor function and results of electrophysiological testing of the affected side (P > 0.05). Conclusions: The method of partial C₇ root transfer results in equally good motor function as does transfer of the whole root, while occurrence of motor and sensory damage is less than that which occurs with transfer of the whole root.     

健侧颈7神经根移位修复多条神经模型的建立及功能恢复动态观察

目的比较七种不同术式的健侧颈，神经根移位术后受体神经的功能以探讨颈，神经重建多组神经的可行性。方法SD大鼠105只，随机分为7组，每组15只。建立传统的健侧颈，移位经尺神经近端（单根）接正中神经或肌皮神经或桡神经（A、D、G组），健侧颈，经尺神经近端（2股，合干法）接正中、肌皮神经或正中、桡神经（B、E组），健侧颈，经尺神经及腓肠神经（分干法）接正中、肌皮神经或正中、桡神经（C、F组）。术后观察患肢功能，抓握力及梳洗动作出现时间。结果术后2个月，修复正中和肌皮神经的B、C组，均出现主动屈趾、屈肘功能。抓握力比较：合干法（B、E组）、分干法（C、F组）及传统法（A、D、G组）的差异均有统计学意义（P〈0．05）。术后3、6个月合干、分干法与传统法比较差异无统计学意义（P〉0．05）。梳洗试验出现时间：合干、分干法及传统法比较差异无统计学意义（P〉0．05）。结论颈，神经根能提供足够的神经再生纤维，可同时恢复2条神经功能。     

Selective transfer of the C7 nerve root: an experimental study

The authors present selective C7 nerve root transfer in a rat model. The musculocutaneous nerve was neurotized by various portions of ipsilateral C7. The latent period and maximum amplitude of evoked motor action potential of the biceps, number of regenerating myelinated nerve fibers, cross-sectional area and wet weight of the biceps, and twitch and tetanic tensions of the biceps were measured at four postoperative intervals. In the early postoperative period (1 and 2 months), nerve regeneration in neurotization with the posterior division or the anterior division of C7 was significantly better than that with the anterolateral fascicles of the anterior division or the phrenic nerve. As the postoperative interval prolonged, the parameters of nerve regeneration in the latter two groups approximated those in the former two groups. This indicated that there were enough regenerating nerve fibers in the anterolateral fascicles of the anterior division and a promising potential for nerve regeneration. The clinical significance of the results lies in the design of selective C7 transfer which, using the anterolateral fascicles of the anterior division, could preserve the function of the muscles innervated by the posterior division to the greatest extent, and provide sufficient donor outflow as well. It is therefore a new option for C7 transfer.     

健侧颈7神经根移位治疗臂丛损伤的疗效观察

目的 观察健侧颈，神经根移位术后患侧肢体的功能恢复及对健侧颈7神经根所支配区运动、感觉的影响。方法 对25例全臂丛神经根性撕脱伤患者，均采用健侧颈7神经根（全部10例，后股15例）移位修复，其中修复上千6例，正中神经13例，桡神经3例，肌皮神经3例；并观察手术前、后健侧颈，神经根所支配肌肉功能和感觉的变化及患侧肢体的功能恢复。术后5～28个月随访到24例。结果 对健侧肢体的影响：10例健侧颈，神经根全部切断者，术后均出现不同程度的感觉运动障碍，主要表现为桡侧1～3指感觉减退、肢体酸胀、痛和不同程度的肢体无力，术后1年完全恢复正常。1例出现伸拇、伸指不能，1年半后仍无明显恢复。15例健侧颈，神经后股切断者，其中1例失访。术后2例无明显感觉障碍，但伸腕、伸指无力，3周后恢复正常。12例出现示、中指感觉异常，8例于术后3～4周后逐渐恢复正常，4例于6个月后症状消失。患肢功能恢复：术后随访至12～18个月，受区神经支配的部分肌肉获得不同程度的功能恢复。结论 健侧颈7神经根移位术后健侧肢体运动感觉功能不遗留明显的远期损害，但也偶有解剖因素导致其支配区功能的无法恢复。颈7后股移位能为受区神经提供足够的运动纤维，同时也减少了对健侧肢体感觉的影响。     

Transfer of brachioradialis motor branch to the anterior interosseous nerve in C8‐T1 brachial plexus palsy. An anatomic study

We present an anatomical and histomorphometric study of the transfer of the motor branch to the brachioradialis muscle to the anterior interosseous nerve in recent brachial plexus lesions, involving C8 and T1 roots. The aim of this study was to demonstrate the anatomic constancy of the nerves involved in the transfer, feasibility, and reproducibility of the transfer. We performed a study of 14 elbows in fresh cadavers. Transfer of the motor branch of the brachioradialis muscle to the anterior interosseous nerve was possible in all specimens; there was constancy in the origin and entry into the muscle of the donor nerve, and it was always possible to dissect the recipient nerve at the level of the donor nerve, thereby allowing for direct coaptation of the nerves. The mean diameter of the anterior interosseous nerve was 2.9 ± 0.5 mm and the mean diameter of the brachioradialis muscle branch was 2 ± 0.4 mm. The branch to the brachioradialis muscle contains an average of 550 ± 64 myelinated axons and the anterior interosseous nerve has an average of 2266 ± 274 myelinated axons. The anatomic study in cadavers showed that the technique is justified and anatomically reproducible. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.     

The use of thoracodorsal nerve transfer in restoration of irreparable C5 and C6 spinal nerve lesions.

There are only a few reports on the use of thoracodorsal nerve (TDN) transfer to the musculocutaneous or axillary nerves in cases of directly irreparable brachial plexus injuries. In this study, we analysed outcome and time-course of recovery in correlation with recipient nerves and type of nerve transfer (isolated or in combination with other collateral branches) for 27 patients with transfer to the musculocutaneous or axillary nerves. Using this nerve as donor, we obtained useful functional recovery in all 12 cases for the musculocutaneous nerve, and in 14 (93.3%) of 15 nerve transfers for the axillary nerve. Although, we found no significant statistical difference between analysed patients according to the percentage of recoveries and mean values, we established a better quality and shorter time of recovery for the musculocutaneous nerve. According to obtained results, we consider that transfer may be a valuable method in reconstruction after directly irreparable C5 and C6 spinal nerve lesions.     

健侧C7神经根移位对修复全臂丛根性撕脱伤术后运动皮层重塑的影响

目的 探讨大鼠全臂丛根性撕脱伤行健侧C7神经根移位术后运动皮层重塑的变化,比较不同术式对运动皮层重塑的影响.方法 建立幼年Sprague-Dawley大鼠左侧全臂丛根性撕脱伤模型90只,随机采用三种不同术式健侧C7神经根移位术治疗,包括健侧C7神经根移位至上干前股(A组,30只),移位至正中和肌皮神经(B组,30只)以及移位至正中神经(C组,30只).分别于术后1.5、3、6、9、12个月,以微电极刺激技术检测各组大鼠患肢支配区在双侧大脑运动皮层的分布.另取6只成年SD大鼠为空白对照组.结果 术后1.5个月,各实验组大鼠患肢支配区仅位于同侧运动皮层;术后3和6个月,患肢支配区均位于双侧运动皮层;术后9个月,A组大鼠患肢支配区已达对侧运动皮层;术后12个月,各实验组大鼠患肢支配区均位于对侧运动皮层,B组运动皮层重塑程度优于C组.结论 幼年大鼠健侧C7神经根移位术后运动皮层患肢支配区可实现由同侧皮层到双侧再到对侧皮层的跨大脑半球功能重翅.健侧C7神经根移位术受体神经的类型影响术后运动皮层重塑,移位至臂丛上干前股或同时移位至正中和肌皮神经更有利于实现运动皮层的跨半球重塑.     

健侧C7椎体前移位联合多组神经移位治疗全臂丛神经根性撕脱伤

目的：探讨健侧C7神经根椎体前移位并联合多组神经移位治疗全臂丛神经根性撕脱伤的方法和疗效。方法对20例全臂丛根性撕脱伤患者采用健侧C7神经根、膈神经、副神经及健侧C7修复患侧下干后形成新的动力神经：臂内侧皮神经、前臂内侧皮神经、下干后股移位修复患侧下干、肌皮神经、肩胛上神经、腋神经、桡神经、正中神经内侧头。并进行长期随访,观察肩外展、屈肘、屈指和伸腕伸指及手部感觉功能恢复的情况。结果20例中有17例获得随访,随访时间20～72个月（平均38个月）。肩外展平均39°,有效率（肌力M2以上）71%,优良率（肌力在M3以上）59％;屈肘平均77°,有效率83%,优良率53％;屈指、屈拇功能恢复：10例指屈肌力≥M2,有效率为59%（10/17）,其中7例肌力≥M3,优良率为42%;伸肘恢复有效率（肌力M2以上）59%,优良率42%;伸指有效率47%,优良率36%。结论健侧C7神经根椎体前移位并联合多组神经移位治疗全臂丛神经根性撕脱伤是有效的治疗方法之一。     

Comparative experimental study on treatment outcome of nerve transfer, using selective C7 nerve root vs. phrenic nerve

The treatment outcome of nerve transfer using the C7 nerve root or phrenic nerve was compared in a rat experiment. One hundred and twenty SD rats were divided into two groups, one undergoing phrenic nerve transfer to the musculocutaneous nerve, and the other partial ipsilateral C7 (anteriolateral fascicles of the anterior division) to the musculocutaneous nerve. Neurotization outcomes of the two groups were evaluated by comparing the electrophysiologic, histologic, and myophysiologic changes of the biceps muscle. No significant differences were found between parameters from the phrenic nerve transfer group and those from the ipsilateral C7 nerve transfer group. This indicates that the treatment outcome of selective ipsilateral C7 transfer is comparable to that of phrenic nerve transfer. It is the surgery of choice in treating brachial plexus upper-trunk avulsion accompanied by phrenic nerve injury.     

健侧颈7神经根移位同时修复两条神经的初步临床疗效

目的探讨用健侧颈，神经根移位同时修复2条上肢神经的临床效果。方法设计2种移位修复的方法。(1)合干法：健侧颈，前后股→尺神经→尺神经近端分2股分别和正中神经、桡神经(或肌皮神经)缝合，共5例。(2)分干法：健侧颈前后股→尺神经、腓肠神经→正中神经、桡神经(或肌皮神经)，共3例。结果合干法4例术后随访12～19个月，1例尚在随访中。正中神经运动：2例已恢复屈腕、屈指，肌力M3。2例屈腕肌力为M1。正中神经感觉：3例为S2，1例为S0。桡神经运动：2例伸腕、伸指肌力为M2。1例伸肘肌力为M2，1例伸腕肌力为M1。桡神经感觉：1例为S2，1例为S1，2例为S0。分干法1例术后随访15个月，已恢复屈腕、屈指，肌力为M3。正中神经感觉为是。肌皮神经：屈肘肌力为M3。另2例术后时间短尚在随访中。结论健侧颈，神经根移位同时修复上肢2条主要神经的新术式，初步应用结果证实是可行的、有效的。     

椎管内修复臂丛神经损伤的解剖及临床应用研究

目的观察通过打开椎管找到残存的臂丛神经根并进行神经修复的可行性。方法甲醛溶液固定的成人尸体标本15具30侧，测量C5-T1，神经前根椎间孔段的直径、长度和有髓神经纤维计数。选择5例臂丛神经损伤患者，2例为椎孔处刀刺伤，3例为闭合性创伤。自受伤到椎管内探查的时间为3-6个月，平均4个月。CTM显示部分已损伤的神经根其椎管内神经前后根仍存在，而锁骨上臂丛神经探查在椎间孔外找不到相应的具有正常结构的神经根近端，通过打开椎管将椎管内残存的神经根用腓肠神经桥接进行神经修复。结果C5-T1，神经前根的有髓神经纤维数目为4000-6000根，椎间孔段的长度为11～14mm，外径为1．2～1．5mm。5例患者的椎管内均找到了具有正常结构的神经根近端，其中C5神经根3例，C5、C6神经根1例，C7神经根1例。C5修复肩胛上神经和C5神经远端各1例，C5修复正中神经内侧头1例，C7修复内侧束1例，C5、C6分别修复上干后股、肌皮神经1例。术后随访38--46个月，平均42个月。5例患者其修复神经所支配肌肉的肌力分别达3-4级。结论对于神经根在椎间孔处断裂的臂丛神经损伤，可通过打开椎管找到损伤神经根的近端，为臂丛神经根性损伤的修复提供理想的动力神经源，有利于臂丛神经治疗效果的提高。     

Hemihypoglossal nerve transfer in brachial plexus repair: technique and results

OBJECTIVE: In multiple avulsions of the brachial plexus, the search for extraplexal donor nerves in the hope of achieving motor neurotization is a major goal. We explored the possibility of using the hypoglossal nerve as a transfer point to reanimate muscles in the upper limb. METHODS: The hypoglossal nerve was used as a donor nerve for neurotization in seven patients with avulsive injuries of the brachial plexus. The surgical technique--an end-to-side microsuture using approximately half of the nerve fascicles--is basically the same as that used in the hypoglossal nerve-facial nerve jump graft, which is a well-known technique in facial nerve reanimation. The recipient nerves were the suprascapular (two patients), the musculocutaneous (one patient), the posterior division of the upper trunk (two patients), and the medial contribution to the median nerve (two patients). RESULTS: In spite of a connection documented by electromyography and selective activation in three of seven patients, the functional results in our patients were extremely disappointing: no patient had an outcome better than M1 in the reinnervated muscles. CONCLUSION: This technique was of no help to the patients and thus has been abandoned at our institution.     

Direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy in the treatment of brachial plexus injury

OBJECT: The authors present the long-term results of nerve grafting and neurotization procedures in their group of patients with brachial plexus injuries and compare the results of "classic" methods of nerve repair with those of end-to-side neurorrhaphy. METHODS: Between 1994 and 2006, direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy were performed in 168 patients, 95 of whom were followed up for at least 2 years after surgery. Successful results were achieved in 79% of cases after direct repair and in 56% of cases after end-to-end neurotization. The results of neurotization depended on the type of the donor nerve used. In patients who underwent neurotization of the axillary and the musculocutaneous nerves, the use of intraplexal nerves (motor branches of the brachial plexus) as donors of motor fibers was associated with a significantly higher success rate than the use of extraplexal nerves (81% compared with 49%, respectively, p = 0.003). Because of poor functional results of axillary nerve neurotization using extraplexal nerves (success rate 47.4%), the authors used end-to-side neurorrhaphy in 14 cases of incomplete avulsion. The success rate for end-to-side neurorrhaphy using the axillary nerve as a recipient was 64.3%, similar to that for neurotization using intraplexal nerves (68.4%) and better than that achieved using extraplexal nerves (47.4%, p = 0.19). CONCLUSIONS: End-to-side neurorrhaphy offers an advantage over classic neurotization in not requiring sacrifice of any of the surrounding nerves or the fascicles of the ulnar nerve. Typical synkinesis of muscle contraction innervated by the recipient nerve with contraction of muscles innervated by the donor was observed in patients after end-to-side neurorrhaphy.     

Study on clinical application of selective transfer of ipsilateral C7 nerve root

Objective:To verify the rationality,reliability and practivability of selective transfer of ipsilateral C7 nerve root for treatment of upper trunk avulsion.Methods:Selective transfer of ipsilateral C7 nerve root was carried out in 8 patients (7 with upper trund avulsion,and 1 with left upper trunk avulsion combined with partial injury of the middle trunk)from June 1996 to Februany 1997.selective transfer of the anterior division or the anteriolateral fascicles of the anterior division of ipsilateral C7 to the anterior division of the upper trunk was performed under general anesthesia.Only 5 cases were followed up.Results:Among these 5 cases,effective recovery was observed on 4 cases of the transfer of the anteriolateral fascicles of ipsilateral C7 to the anterior division of the upper trunk.Electromyogyaphic examination showed nerve regeneration could be observed in the 2nd month postoperatively.And detectable elbow flexion by biceps contraction was found in the 4th month postoperatively.The function of the C7 innervating muscles was not jeopardized,and the case with combined partial C7 root injury had a poor result.Conclusions:Selective transfer of ipsilateral C7 nerve root leads to a restoration of reinnervating muscle functions without affecting the function of the muscles innervated by C7.It is therefore a practicable new surgical procedure for treating upper trunk avulsions.     

Outcome of contralateral C7 transfer to two recipient nerves in 22 patients with the total brachial plexus avulsion injury

The treatment of total brachial plexus avulsion injury is difficult with unfavorable prognosis. This report presents our experience on the contralateral C7 (CC7) nerve root transfer to neurotize two recipient nerves in the patients with total BPAI. Twenty‐two patients underwent CC7 transfer to two target nerves in the injured upper limb. The patients' ages ranged from 13 to 48 years. The entire CC7 was transferred to pedicled ulnar nerve in the first stage. The interval between trauma and surgery ranged from 1 to 13 months. The ulnar nerve was transferred to recipients (median nerve and biceps branch or median nerve and triceps branch) at 2–13 months after first operation. The motor recovery of wrist and finger flexor to M3 or greater was achieved in 68.2% of patients, the sensory recovery of median nerve area recovered to S3 or greater in 45.5% of patients. The functional recovery of elbow flexor to M3 or greater was achieved in 66.7% of patients with repair of biceps branch and 20% of patients with repair of the triceps branch (P < 0.05). There were no statistical differences in median nerve function recovery at comparisons of the age younger and older than 20‐years‐old and the intervals between trauma and surgery. In conclusion, the use of CC7 transfer for repair two recipient nerves might be an option for treatment of total BPAI. The functional recovery of the repaired biceps branch appeared to be better than that of the triceps branch. © 2013 Wiley Periodicals, Inc. Microsurgery 33:605–611, 2013.