Back to 2012 Annual Meeting Program
C6 to C5 Nerve Transfer in Obstetric Brachial Plexus Lesions
Martijn J.A. Malessy, PhD; Willem Pondaag, MD
LUMC, Leiden, Netherlands
The primary goal of nerve repair in patients with C5, C6 (C7, C8) Obstetric Brachial Plexus Lesions (OBPL) is restoration of biceps muscle function.
In a part of the C5, C6 (C7, C8) lesion type, C5 can be used as a proximal nerve stump for grafting, but C6 is not available because this root is either avulsed or neurotmetic at the intraforaminal level. Frequently, biceps muscle reinnervation is than sought after by applying distal nerve transfers to the musculocutaneous nerve.
One of the claimed advantages of such distal transfers is the short reinnervation time because direct coaptation is performed close to the target organ. In addition, the surgery is relatively easy. We applied an alternative strategy in which a proximal transfer was performed of the distal C6 root to the C5 stump preferably with direct coaptation.
Methods: Between 1990 and 2008, nerve surgery was performed in 421 OBPL patients. Twenty-one infants had a neurotmetic lesion C5 and avulsion or intraforaminal neurotmesis C6, irrespective of C7 and C8 function. Intraplexal nerve transfer of C6 to C5 could be performed with direct coaptation 17 (81%) times and with graft interpositioning in the remaining four patients. The C6 anterior root filaments were coapted to C5 seven times (33%) and in the remaining 14 the entire C6 root was used.
Results: Biceps muscle function ≥ MRC 4 was achieved in 20/21 patients (95%) after a mean follow-up of at least 30 months. One patient had biceps MRC grade 3.
Conclusion: Intraplexal nerve transfer of C6 to C5 provides good biceps muscle function recovery in a high percentage of patients. This transfer has a number of advantages. 1) The surgical area is limited to the supraclavicular region. 2) There is no donor site morbidity. 3) Usually a direct coaptation can be performed. Proximal C6 to C5 transfer should be considered as one of the reconstruction options in specific OBPL lesion types.
Back to 2012 Annual Meeting Program