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CC7 Transfer For BPI – Experience in Pre-spinal Route
Lei Xu, MD, PhD; Jiuzhou Lu, MD, PhD; Li Chen, MD, PhD; Jianguang Xu, MD, PhD
Huashan Hospital, Fudan University, Shanghai, China
Objective: We sought to investigate a shorter and safer route for contralateral C7 transfer.
Methods: 36 patients were treated from December 2005 to November 2009. Their ages ranged from 10 to 40 years old. 24 patients had total brachial plexus avulsion. The operative delay was from 2 to 6 months (mean, 4 months). The modified bilateral scalenus anterior muscles were transected before a prespinal and retropharyngeal tunnel was made. The contralateral C7 nerve root was used to repair the upper trunk, the lower trunk, or the C6 and C8 nerve roots of the injured side via this route, with the use of direct neurorrhaphy or nerve grafting.
Results: The length of the harvested contralateral C7 nerve root was 6.2±0.52 cm on average in most of patients. All operations were uncomplicated, with no injury of the esophagus, major blood vessels, pleura or thoracic duct during or after the operation. Transient contralateral sensory symptoms were reported in most patients. In all cases, elbow flexion and shoulder abduction recovered by 12 months postoperatively, however, finger flexion recovered by 24 months postoperatively.
Conclusion: Transection of the modified bilateral scalenus muscles can reduce the length of the nerve graft and allow the C7 nerve to be transferred more smoothly and safely through the prespinal and retropharyngeal route; this method also favors nerve regeneration and functional recovery.
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