Introduction We describe a new technique for treating traumatic brachial plexus avulsion injury with a contralateral C7 nerve transfer with direct coaptation that shortens the time to muscle reinnervation.
Step 1: Explore the Injured Brachial Plexus Explore the brachial plexus carefully and confirm the nerve-root avulsion injuries from C7 to T1.
Step 2: Harvest the Contralateral C7 Nerve Dissect the divisions of the contralateral C7 nerve root, divide the nerve at the junction between the divisions and cords, and mobilize it proximally.
Step 3: Create the Prespinal Route Create the prespinal route to guide the contralateral C7 nerve to the injured side.
Step 4: Humeral Shortening Osteotomy If the contralateral C7 nerve does not reach the injured lower trunk, perform a humeral shortening osteotomy, generally with <5 cm of shortening in adults.
Step 5: Neurorrhaphy Suture one end of the sural nerve together with the medial antebrachial cutaneous nerve to the musculocutaneous nerve; anastomose the remainder of the contralateral C7 nerve directly with the lower trunk.
Step 6: Postoperative Care Use a prefabricated brace to hold the head in the neutral position and immobilize the injured limb for six weeks.
Results We evaluated the results of the technique in a study of seventy men and five women with a mean age (and standard deviation) of 28 ± 10 years (range, ten to fifty-three years).
Pitfalls & Challenges
We describe a new technique for treating traumatic brachial plexus avulsion injury with a contralateral C7 nerve transfer with direct coaptation that shortens the time to muscle reinnervation.
In patients with a total brachial plexus avulsion injury, the contralateral C7 nerve, which provides sufficient myelinated axons, has been used as a donor nerve to repair the injured median nerve. The results of using this technique for restoration of finger flexion have …
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