American Society for Peripheral Nerve

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Retropharyngeal Contralateral C7 Nerve Transfer to the Lower Trunk for Brachial Plexus Birth Palsy: Technique and Results
Anthony Thanh Vu, MD
Cincinnati Children's Medical Center, Cincinnati, OH

Introduction: Brachial plexus birth palsies can lead to significant long-term morbidity, even when surgical treatment is attempted. Multiple nerve root avulsions present a particularly difficult problem for reconstruction due to the limited amount of donor nerves. The contralateral cross-C7 (CC7) nerve has been described for use as a donor nerve but mostly in adolescents and adults. More recently, the CC7 transfer via the retropharyngeal route has been described in attempt to improve outcomes owing to shorter nerve grafts. We present our technique and early results for the retropharyngeal CC7 nerve transfer to the lower trunk.

Methods: A retrospective review over the past 4 years was performed. We included any child less than 2 years of age who received a CC7 nerve transfer via the retropharyngeal route to the lower trunk for brachial plexus birth palsy. Charts were analyzed for patient demographic data, operative variables, postoperative motor and sensory recovery, length of hospital stay, and length of follow up. Complications related to the retropharyngeal dissection and the donor limb were also recorded.

Results: We had a total of five patients. Average age at the time of surgery was 157 days. Average operative time was 5.7 hours. Average hospital stay was 2 days. Average nerve graft length was 3cm. Variable degrees of hand sensation were present in all patients by 9 months. All patients had unprompted use of the recipient limb, independent of the donor limb. All patients had at least an AMS of 2/7 for finger and thumb flexion; one patient had an AMS of 7/7 for finger and thumb flexion. Only one patient has had return of intrinsic hand function with an AMS of 3/7. Regarding donor site complications, two patients had temporary triceps weakness and one patient had clinically insignificant temporary phrenic nerve paresis. There were no complications related to the retropharyngeal nerve dissection in any patient. Average length of follow up was 3.3 years. A retrospective review of nine patients who also underwent the CC7 nerve transfer for other reasons did not demonstrate any permanent complications related to the donor limb or retropharyngeal dissection.

Conclusion: The retropharyngeal CC7 nerve transfer is a safe way of supplying extra axons to the severely injured arm in birth-related brachial plexus injuries without any permanent donor limb deficits. Early functional recovery in our patients with regard to hand function and sensation is promising.

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