Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Jul 15;7(20):1545-55.
doi: 10.3969/j.issn.1673-5374.2012.20.004.

Improved C3-4 transfer for treatment of root avulsion of the brachial plexus upper trunk: Animal experiments and clinical application

Lin Zou  1 , Xuecheng Cao  1 , Jing Li  2 , Lifeng Liu  1 , Pingshan Wang  1 , Jinfang Cai  1
Affiliations

Improved C3-4 transfer for treatment of root avulsion of the brachial plexus upper trunk: Animal experiments and clinical application

Lin Zou et al. Neural Regen Res. .

Abstract

Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C3-4 transfer for neurotization of C5-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 + phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level III-IV, scapular muscle to level III-IV, latissimus dorsi and pectoralis major muscles to above level III, and the brachial triceps muscle to level 0-III. Results showed that the improved C3-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.

Keywords: brachial plexus; cervical plexus; nerve transfer; neural regeneration; peripheral nerve injury; phrenic nerve; root avulsion; translational medicine; upper trunk.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None declared.

Figures

Figure 1
Figure 1
Morphology of C3-6 myelinated nerve fibers in rats of each group (hematoxylin-eosin staining, light microscope, × 400). (A) C3 in normal control group; (B) C3 in experimental group at 3 months; (C) C3 in experimental group at 6 months; (D) C4 in normal control group; (E) C4 in experimental group at 3 months; (F) C4 in experimental group at 6 months; (G) C5 in normal control group; (H) C6 in normal control group.
Figure 2
Figure 2
Ultrastructure of transverse myelinated nerve fibers (transmission electron microscope) showing focal myelin thickening in rats. (A) C3 in normal control group (× 8 000); (B) C4 in normal control group (× 5 000); (C) C5 in normal control group (× 9 000); (D) C6 in normal control group (× 6 000); (E) C5 in experimental group at 3 months (× 15 000); (F) C5 in experimental group at 6 months (× 20 000); (G) C6 in experimental group at 3 months (× 8 000); (H) C6 in experimental group at 6 months (× 20 000).
Figure 3
Figure 3
Axillary nerve (upper) and musculocutaneous nerve (lower) motor evoked potentials before (A) and 1 year after surgery (B).
Figure 4
Figure 4
Axillary nerve (A) and musculocutaneous nerve (B) motor evoked potentials at 1.5 years post-surgery.
Figure 5
Figure 5
Biceps brachii muscle (A) and deltoid muscle (B) regeneration potentials at 1.5 years post-surgery.
Figure 6
Figure 6
The avulsed C5-6 nerve root and the anatomically separated C3-4 nerve root (long green arrow indicates C3, short green arrow C4, long black arrow C5, short black arrow C6).
Figure 7
Figure 7
C3 and C4 + phrenic nerve anastomosis. (A) Surgical diagram; (B) gross observation after surgery.
Figure 8
Figure 8
C3 and C4 + phrenic nerve transfer for treatment of C5-6 root avulsion.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Tsuyama N, Hara T. Intercostal nerve transfer in the treatment of brachial plexus injury of root avulsion type. In: Delchef J, de Mameffe R, Vander Elst E, editors. Orthopaedic Surgery and Traumatology. Amesterdam: International Congress Series No. 291, Excerpta Medica; 1973. pp. 351–353.
    1. Gu YD, Wu MM, Zheng YL, et al. Phrenic nerve transfer treating root avulsion of the brachial plexus. Zhonghua Wai Ke Za Zhi. 1989;27(7):433–435. 447. - PubMed
    1. Oberlin C, Béal D, Leechavengvongs S, et al. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am. 1994;19(2):232–237. - PubMed
    1. Gu YD, Zhang GM, Chen DS, et al. Cervical nerve root transfer from the healthy side in the treatment of brachial plexus root avulsion. Zhonghua Yi Xue Za Zhi. 1989;69(10):563–538. - PubMed
    1. Xu JG, Hu SN, Wang H, et al. Histochemical study on C7 roots and its clinical significance. Zhongguo Linchuang Jiepou Xue Zazhi. 1996;14(4):243–245.