Surgical treatment for total root avulsion type brachial plexus injuries by neurotization: A prospective comparison study between total and hemicontralateral C7 nerve root transfer

• Published in: Microsurgery 2014-02, Vol.34 (2), p.91-101
• Main Authors: Tu, Yuan-Kun, Tsai, Yi-Jung, Chang, Chih-Han, Su, Fong-Chin, Hsiao, Chih-Kun, Tan, Jacqueline Siau-Woon
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Brachial Plexus - injuries; Brachial Plexus - surgery; Clinical; Female; Humans; Male; Nerve Transfer - methods; Prospective Studies; Radiculopathy - surgery; Recovery of Function; Young Adult
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.22148

Purpose: We conducted a clinical study to evaluate the effects of neurotization, especially comparing the total contralateral C7 (CC7) root transfer to hemi‐CC7 transfer, on total root avulsion brachial plexus injuries (BPI). Methods: Forty patients who received neurotization for BPI were enrolled in this prospective study. Group 1 (n = 20) received hemi‐CC7 transfer for hand function, while group 2 (n = 20) received total‐CC7 transfer. Additional neurotization included spinal accessory, phrenic, and intercostal nerve transfer for shoulder and elbow function. The results were evaluated with an average of 6 years follow‐up. Results: Group 1 had fewer donor site complications (15%) than group 2 (45%); group 2 had significantly better hand M3 and M4 motor function (65%) than group 1 (30%; P = 0.02). There was no difference in sensory recovery. Significantly, better shoulder function was obtained by simultaneous neurotization on both suprascapular and axillary nerves. Conclusions: Total‐CC7 transfer had better hand recovery but more donor complications than hemi‐CC7. Neurotization on both supra‐scapular and axillary nerves improved shoulder recovery. © 2013 The Authors. Microsurgery published by Wiley Periodicals, Inc. Microsurgery 34:91–101, 2014.