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Randomized Controlled Trial
. 2014 Feb;34(2):91-101.
doi: 10.1002/micr.22148. Epub 2013 Aug 2.

Surgical treatment for total root avulsion type brachial plexus injuries by neurotization: a prospective comparison study between total and hemicontralateral C7 nerve root transfer

Yuan-Kun Tu  1 , Yi-Jung Tsai, Chih-Han Chang, Fong-Chin Su, Chih-Kun Hsiao, Jacqueline Siau-Woon Tan
Affiliations
Free PMC article
Randomized Controlled Trial

Surgical treatment for total root avulsion type brachial plexus injuries by neurotization: a prospective comparison study between total and hemicontralateral C7 nerve root transfer

Yuan-Kun Tu et al. Microsurgery. 2014 Feb.
Free PMC article

Abstract

Purpose: We conducted a clinical study to evaluate the effects of neurotization, especially comparing the total contralateral C7 (CC7) root transfer to hemi-CC7 transfer, on total root avulsion brachial plexus injuries (BPI).

Methods: Forty patients who received neurotization for BPI were enrolled in this prospective study. Group 1 (n = 20) received hemi-CC7 transfer for hand function, while group 2 (n = 20) received total-CC7 transfer. Additional neurotization included spinal accessory, phrenic, and intercostal nerve transfer for shoulder and elbow function. The results were evaluated with an average of 6 years follow-up.

Results: Group 1 had fewer donor site complications (15%) than group 2 (45%); group 2 had significantly better hand M3 and M4 motor function (65%) than group 1 (30%; P = 0.02). There was no difference in sensory recovery. Significantly, better shoulder function was obtained by simultaneous neurotization on both suprascapular and axillary nerves.

Conclusions: Total-CC7 transfer had better hand recovery but more donor complications than hemi-CC7. Neurotization on both supra-scapular and axillary nerves improved shoulder recovery.

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Figures

Figure 1
Figure 1
SAN to SSN neurotization was performed to reconstruct shoulder function. The coaptation suture was accomplished using 10-0 nylon sutures. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Figure 2
Figure 2
The SUCV for the VUNG was identified and well protected. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Figure 3
Figure 3
Neurotization procedures were performed with third and fourth ICN transfer to Axi, and fifth and sixth ICN transfer to MCN. The nerve coaptations were done using 10-0 nylon sutures and tissue glue. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Figure 4
Figure 4
After a cross-chest route transfer, the distal end of VUNG was sutured to the nerve ending of total-CC7 (group 2 patients) with 10-0 nylon microsutures. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Figure 5
Figure 5
The whole surgical field of neurotization for BPI, including ICN-MCN and cross-chest CC7 transfer with VUNG through the subcutaneous tunnel. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Figure 6
Figure 6
A: Comparison of shoulder motor recovery in single nerve (PN-SS or SA-SS) and double nerve (SA-SS+ ICN-AXI) procedures. B: Comparison of elbow motor recovery in ICN-MCN and SA-NG-MCN.
Figure 7
Figure 7
Comparisons of shoulder range of motion in single nerve (PN-SS or SA-SS) and double nerve (SA-SS+ ICN-AXI) procedures. *: PN-SS vs. SA-SS + ICN-AXI, P < 0.05. #: SA-SS vs. SA-SS + ICN-AXI, P < 0.05.
Figure 8
Figure 8
Patients in group 1 received hemi-CC7 transfer for right total root avulsion BPI. The right hand shows M3 motor recovery with hook grip function. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Figure 9
Figure 9
Patients in group 2 received total-CC7 transfer for right total root avulsion BPI. The right hand shows M4 motor recovery with hook grip function. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
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References

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