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Contralateral C7 Nerve Transfer for Pediatric Brachial Plexus Injuries: Donor Site Morbidity
Neel Bhagat, BS1; Jeffrey Gross, MD1; Joshua M Adkinson, MD1; Gregory Borschel, MD2
1Indiana University School of Medicine, Indianapolis, IN; 2Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN

Background Brachial plexus injuries (BPI) can have a devastating impact on upper limb function. Fortunately, advancements in peripheral nerve surgery have improved outcomes after such injuries. With localized lesions, nerve grafting and intra-plexal nerve transfers are well-described. However, reconstruction of pan-plexus (C5-T1) injuries requires donor nerves which do not arise from the injured brachial plexus. Commonly utilized extra-plexal options include the intercostal and spinal accessory nerves. While well-described in the literature, these transfers alone are not capable of providing adequate innervation to motor targets in the setting of a pan-plexus injury. To address this, our brachial plexus team utilizes a cross C7 (CC7) nerve transfer extended with sural nerve grafts to the contralateral recipient nerve. We present a case series of 3 pediatric patients who underwent CC7 transfer for BPI. Objective: to catalogue any donor site morbidity incurred by transferring the C7 root.
Methods This retrospective study was approved by the Institutional Review Board of Indiana University. Inclusion criteria: patients under 18 years old that underwent CC7 nerve transfer to the brachial plexus at Indiana University Health and Sidney and Lois S. Eskenazi Hospital between 2021-2022. A chart review was completed to collect demographic and outcomes data.
Results Three patients underwent a CC7 transfer between 2021-2022 for BPI reconstruction. Two patients (66.6%) underwent CC7 for injuries sustained during birth. One patient (33.3%) underwent CC7 for injuries sustained during a motor vehicle collision. All patients underwent concomitant transfer of the spinal accessory nerve to suprascapular nerve, and two patients (66.6%) underwent transfer of intercostal nerves 3-5 to the musculocutaneous nerve. Post-operative donor site sensory deficits were minimal and transient in all but one patient, who reports mild but persistent paresthesias of the donor side hand only during passive movement of recipient side digits. No patients had donor site motor deficits (Table 1).
Conclusions In this series, there were minimal and transient donor arm sensory deficits, and no motor deficits to the donor arm following CC7 transfer. We conclude in this pilot series that CC7 nerve transfer is a safe surgical option to provide additional motor donors for pan-plexus injuries in pediatric patients.


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