Minimum 4-year follow-up on contralateral C7 nerve transfers for brachial plexus injuries

Purpose: Contralateral C7 (CC7) transfer for brachial plexus injuries (BPI) can benefit finger sensation but remains controversial regarding restoration of motor function. We report our 20-year experience using CC7 transfer for BPI, all of which had at least 4 years of follow-up. Methods: A total of 137 adult BPI patients underwent CC7 transfer from 1989 to 2006. Of these patients, 101 fulfilled the inclusion criteria for this study. A single surgeon performed all surgeries. A vascularized ulnar nerve graft, either pedicled or free, was used for CC7 elongation. The vascularized ulnar nerve graft was transferred to the median nerve (group 1, 1 target) in 55 patients, and to the median and musculocutaneous nerves (group 2, 2 targets) in 23 patients. In another 23 patients (group 3, 2 targets, 2 stages), the CC7 was transferred to the median nerve (17 patients) or to the median and musculocutaneous nerve (6 patients) during the first stage, followed by functioning free muscle transplantation for finger flexion. Results: We considered finger flexion strength greater or equal to M3 to be a successful functional result. Success rates of CC7 transfer were 55%, 39%, and 74% for groups 1, 2, and 3, respectively. In addition, the success rate for recovery of elbow flexion (strength M3 or better) in group 2 was 83%. Conclusions: In reconstruction of total brachial plexus root avulsion, the best option may be to adopt the technique of using CC7 transfer to the musculocutaneous and median nerve, followed by FFMT in the early stage (18 mo or less) for finger flexion. Such a technique can potentially improve motor recovery of elbow and finger flexion in a shorter rehabilitation period (3 to 4 y) and, more importantly, provide finger sensation to the completely paralytic limb. Type of study/level of evidence: Therapeutic II.