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Recovering Extension Function Using a Modified Contralateral C7 Neurotization in BPAI Patients
Su Jiang, MD
Huashan Hospital, Fudan University, Shanghai, China

Backgrounds: In brachial plexus injuries with nerve root avulsions, the options for nerve reconstruction are limited. More and more emphasis has been put on the extension function of the paralyzed limb. Contralateral C7(CC7)transfer has gained international acceptance in treating brachial plexus avulsion injuries, however the results has not been satisfactory when neurotizing median nerve for flexion function recovery, mainly because of a long nerve regeneration process and irreversible muscle atrophy. It is of interest to know how it works when transferring to recover extension function, this report presents our results of extension function recovery using a new procedure involving contralateral C7 nerve transfer directly to the injured middle trunk in patients with BPAI.

Methods: Five male patients were treated from December 2012 to March 2014. Their ages ranged from 22 to 35 years (average, 28 yr). The interval between trauma and surgery ranged from 2 to 6 months(mean, 4 mo). All patients had total brachial plexus avulsion, which were confirmed during the operation. The contralateral C7 nerve root was sacrificed totally and its distal end was transferred to the proximal end of the middle trunk supraclavicularly behind the musculi sternocleidomastoideus, with the sural nerve grafting. One month aRecovery of elbow, wrist and finger extension was evaluated with use of the modified British Medical Research Council muscle grading system. Electromyography studies were also included.

Results: The length of the harvested contralateral C7 nerve root was 4.5 0.5 cm. The nerve graft was 9.5 2.5 cm long. Transient contralateral sensory symptoms were reported in all patients, weakness of elbow extension were also monitored in 2 patients, which recovered within 3 months postsurgery. The mean follow-up period (and standard deviation) was 24 5 months (range, ninteen to twenty-nine months). Compound muscle action potentials(CMAP) could be recorded 9 2 months postsurgery on the triceps long head, and 15 4 months postsurgery on the ECRL. Motor function with a grade of M3+ or greater was attained in all the patients for elbow extension, 80% of the patients for wrist extension, 60% of the patients for finger and thumb extension.

Conclusion: This modified procedure of transferring contralateral C7 nerve root directly to the injured middle trunk favors successful nerve regeneration and functional recovery extension, which might provide new option for treatment of total BPAI.

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