Shu-Feng Wang1, Yun-Hao Xue1. 1. Department of Hand Surgery, Beijing Jishuitan Hospital, No. 31 East Street of Xinjiekou, West District, Beijing 100035, Republic of China. E-mail address for Y.-h. Xue: xuyuha2006@126.com.
Abstract
INTRODUCTION: We describe a new technique for treating traumatic brachial plexus avulsion injury with a contralateral C7 nerve transfer with direct coaptation that shortens the time to muscle reinnervation. STEP 1 EXPLORE THE INJURED BRACHIAL PLEXUS: Explore the brachial plexus carefully and confirm the nerve-root avulsion injuries from C7 to T1. STEP 2 HARVEST THE CONTRALATERAL C7 NERVE: Dissect the divisions of the contralateral C7 nerve root, divide the nerve at the junction between the divisions and cords, and mobilize it proximally. STEP 3 CREATE THE PRESPINAL ROUTE: Create the prespinal route to guide the contralateral C7 nerve to the injured side. STEP 4 HUMERAL SHORTENING OSTEOTOMY: If the contralateral C7 nerve does not reach the injured lower trunk, perform a humeral shortening osteotomy, generally with <5 cm of shortening in adults. STEP 5 NEURORRHAPHY: Suture one end of the sural nerve together with the medial antebrachial cutaneous nerve to the musculocutaneous nerve; anastomose the remainder of the contralateral C7 nerve directly with the lower trunk. STEP 6 POSTOPERATIVE CARE: Use a prefabricated brace to hold the head in the neutral position and immobilize the injured limb for six weeks. RESULTS: We evaluated the results of the technique in a study of seventy men and five women with a mean age (and standard deviation) of 28 ± 10 years (range, ten to fifty-three years).IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: We describe a new technique for treating traumatic brachial plexus avulsion injury with a contralateral C7 nerve transfer with direct coaptation that shortens the time to muscle reinnervation. STEP 1 EXPLORE THE INJURED BRACHIAL PLEXUS: Explore the brachial plexus carefully and confirm the nerve-root avulsion injuries from C7 to T1. STEP 2 HARVEST THE CONTRALATERAL C7 NERVE: Dissect the divisions of the contralateral C7 nerve root, divide the nerve at the junction between the divisions and cords, and mobilize it proximally. STEP 3 CREATE THE PRESPINAL ROUTE: Create the prespinal route to guide the contralateral C7 nerve to the injured side. STEP 4 HUMERAL SHORTENING OSTEOTOMY: If the contralateral C7 nerve does not reach the injured lower trunk, perform a humeral shortening osteotomy, generally with <5 cm of shortening in adults. STEP 5 NEURORRHAPHY: Suture one end of the sural nerve together with the medial antebrachial cutaneous nerve to the musculocutaneous nerve; anastomose the remainder of the contralateral C7 nerve directly with the lower trunk. STEP 6 POSTOPERATIVE CARE: Use a prefabricated brace to hold the head in the neutral position and immobilize the injured limb for six weeks. RESULTS: We evaluated the results of the technique in a study of seventy men and five women with a mean age (and standard deviation) of 28 ± 10 years (range, ten to fifty-three years).IndicationsContraindicationsPitfalls & Challenges.