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Contralateral C7 transfer for the treatment of brachial plexus root avulsions in children - a report of 12 cases.
by Chen L, Gu YD, Hu SN, Xu JG, Xu L, Fu YThe Journal of hand surgery.
Article Abstract:
PURPOSE: To retrospectively determine the risks and benefits of contralateral C7 nerve root transfer in infants and children. METHODS: In 12 infants and children with brachial plexus root avulsions from birth injury or other trauma, the common trunk of the contralateral C7 root was transferred to the trunk, division, cord, or nerve branch(es) on the affected side with 2 different types of interposition grafts. The surgery was performed in 1 stage for 5 patients and in 2 stages for 7 patients. RESULTS: Patients were followed up for a mean of 42 months, with a minimum of 21 months. Noteworthy function (> or = M2+, modified British Medical Research Council grading system) was gained in 10 of 12 patients and sensory function (> or = S3, British Medical Research Council grading system) was gained in all patients. Improvements in strength and sensation were accompanied by little synchronous motion and sensibility changes in the donor limb in 7 children, to whom the repaired nerves were those innervating the shoulder and/or elbow or both the musculocutaneous and median nerves. In addition to slight damage to the sensory function of the median nerve, 2 infants also had temporarily reduced shoulder abduction on the healthy side. CONCLUSIONS: For contralateral C7 transfer in infants and children with brachial plexus root avulsions, the deficit created by the procedure is minimal and motor and sensory function is gained. Transfer of the contralateral C7 root to different nerves for a child may improve the quality of functional recovery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
Contralateral C7 transfer for the treatment of brachial plexus root avulsions in children - a report of 12 cases.
By: Anonymous - Tue 2/27/2007 PMOverall, their results with this technique was better than what is seen in adults: 10/12 children recovered at least partial function against gravity (M2+), even when surgery was delayed beyond one year (especially for arm flexion). Furthermore, conventional cutaneous nerve grafts from contralateral C7 to the the proximal brachial plexus showed a good result in 3 patients, which is not usually the case with adults, where non-vascularized grafts from C7 are avoided. These outcomes may reflect the shorter graft lengths required, or a child's likely greater potential for regeneration or cortical plasticity. Of interest, no median nerve innervated hand intrinsic muscles recovered when the ulnar graft was coapted to the whole, or medial, portion of the median nerve.
A curious morbidity occurred in the donor limb of 2 patients: they had significant shoulder abduction (and flexion?) weakness (movement to about 75 degrees), which resolved at 2-3 weeks. The authors report neurophysiological testing was negative (as expected this soon after surgery), and theorize that perhaps it was from C7 contribution to the deltoid. One can also speculate it may be secondary to serratus anterior denervation (I guess possible), or perhaps it was related to incisional pain (unlikely)?
Source: http://peripheralnervesurgery.blogspot.com/in...