Outcome of contralateral C7 transfer to two recipient nerves in 22 patients with the total brachial plexus avulsion injury

Gao, Ke; Lao, Jie; Zhao, Xin; Gu, Yajia

doi:10.1002/micr.22137

Cited by 42 publications

(34 citation statements)

References 33 publications

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“…37 On the other hand, elbow and wrist extension functions are not as critical for the patients with total brachial plexus injury; therefore, only a few reports of CC7 transfer to radial or triceps nerve, which contained a small number of patients. 7, 17–19, 38, 43, 49 In our study, 66% of the included patients had total brachial plexus avulsion injuries; spontaneous recovery innervated with the other root is very unlikely. The short distance between CC7 and biceps and triceps muscles could possibly contribute to these enhanced recoveries.…”

Section: Discussionmentioning

confidence: 55%

“…Fourteen studies reported outcomes of multiple procedures. 7, 10, 17–19, 28, 30, 31, 37, 38, 40, 43, 46, 49 …”

Section: Resultsmentioning

confidence: 99%

“…The largest series of 96 patients in one study was conducted by Waikakul. 21 Gu and his colleagues presented 181 out of 754 patients (24%) in 15 studies, 7, 14–18, 29, 30, 32, 33, 35, 39, 43–45 and other surgeons from China reported 170 out of 754 patients (23%) in 6 studies 25, 34, 37, 38, 42, 46 .…”

Section: Resultsmentioning

confidence: 99%

“… § N, number; y, year; Pre-op, pre-operative; mo, month. € Other nerves include upper trunk, lower trunk, lateral cord and posterior cord, thoracodorsal nerve, axillary nerve, suprascapular nerve and ulnar nerve. £ One study (Terzis 2009 19 ) reported 5 procedures; three studies (Gu 1992 17 , Gu 1998 18 , Gu 2002 7 ) reported 4 procedures; four studies (Hattori 2005 49 , Chen 2007 30 , Muhetidier 2011 38 , Gao 2013 43 ) reported 3 procedures; six studies (Beaulieu 2006 28 , Hierner 2007 31 , Lin 2011 37 , Sammer 2012 10 , Chuang 2012 40 , Wang 2013 46 ) reported 2 procedures; thus, there are 39 reference studies. ¥ One study (Terzis 2009 19 ) reported 2 procedures; thus, there are 8 reference studies. ‡ There are 56 patients underwent CC7 transfer to 93 target nerves. In addition, 46 patients underwent CC7 transfer to both MC and median nerves, 47 patients underwent CC7 transfer to both MC nerve and lower trunk, 10 patients underwent CC7 transfer to both median and triceps nerves, 1 patient underwent CC7 transfer to both radial and suprascapular nerves, and 1 patient underwent CC7 transfer to both MC and thoracodorsal nerves; thus actually there are 754 patients included in this systematic review.…”

Section: Figurementioning

confidence: 99%

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A Systematic Review of Contralateral C7 Transfer for the Treatment of Traumatic Brachial Plexus Injury

Yang

Chang

Chung

2015

Plastic and Reconstructive Surgery

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Background Contralateral C7 (CC7) transfer has been used for treating traumatic brachial plexus injury. However, the effectiveness of CC7 transfer remains a subject of debate. We performed a systematic review to study the overall outcomes of CC7 transfer to different recipient nerves in traumatic brachial plexus injuries. Methods A literature search was conducted using PubMed and EMBASE databases to identify original articles related to CC7 transfer for traumatic brachial plexus injury. The data extracted were study/ patient characteristics, and objective outcomes of CC7 transfer to the recipient nerves. We normalized modifications of MRC and other outcome measures into an MRC-based outcome scale for comparisons. Results Thirty-nine studies were identified. The outcomes were categorized based on the three major recipient nerves: median, musculocutaneous, and radial/triceps nerves. Regarding overall functional recovery, 11% of patients achieved MRC grade M4 wrist flexion and 38% achieved M3. Grade M4 finger flexion was achieved by 7% of patients whereas 36% achieved M3. Finally, 56% of patients achieved ≥S3 sensory recovery in the median nerve territories. In the musculocutaneous nerve group, 38% of patients regained elbow flexor strength to M4 and 37% regained to M3. In the radial/triceps nerve group, 25% regained elbow or wrist extension strength to an MRC grade M4 and 25% regained to M3. Conclusions Outcome measures in the included studies were not consistently reported to uncover true patient-related benefits from the CC7 transfer. Reliable and validated outcome instruments should be applied to critically evaluate patients undergoing CC7 transfer.

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Section: Discussionmentioning

confidence: 55%

“…Fourteen studies reported outcomes of multiple procedures. 7, 10, 17–19, 28, 30, 31, 37, 38, 40, 43, 46, 49 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review of Contralateral C7 Transfer for the Treatment of Traumatic Brachial Plexus Injury

Yang

Chang

Chung

2015

Plastic and Reconstructive Surgery

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“…Previous studies have described limited results using grafts, supraclavicular nerve, intercostal nerves or contralateral C7 as donors [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Detailed data are shown in Table 2.…”

Section: Discussionmentioning

confidence: 99%

Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor

Foroni

Siqueira

Martins

et al. 2017

Arq. Neuro-Psiquiatr.

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ARTICLEGood sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor The treatment of complete brachial plexus avulsion remains a challenge for nerve surgeons 1,2 . The recovery of motor function continues to be the priority in brachial plexus reconstruction, but restoration of the sensitivity to sensory stimuli in the hand of patients who have regained movement and function in their arms should also be a priority.In a previous study, our group demonstrated the anatomical feasibility of using the intercostobrachial nerve (ICBN) as a donor of sensory fibers to the lateral cord contribution to the median nerve (LCMN) 3. The purpose of this study was to report the detailed clinical results of sensory recovery in the hand, using this technique in patients with complete brachial plexus injury. ABSTRACTObjective: Restoration of the sensitivity to sensory stimuli in complete brachial plexus injury is very important. The objective of our study was to evaluate sensory recovery in brachial plexus surgery using the intercostobrachial nerve (ICBN) as the donor. Methods:Eleven patients underwent sensory reconstruction using the ICBN as a donor to the lateral cord contribution to the median nerve, with a mean follow-up period of 41 months. A protocol evaluation was performed. Results: Four patients perceived the 1-green filament. The 2-blue, 3-purple and 4-red filaments were perceptible in one, two and three patients, respectively. According to Highet's scale, sensation recovered to S3 in two patients, to S2+ in two patients, to S2 in six patients, and S0 in one patient. Conclusion: The procedure using the ICBN as a sensory donor restores good intensity of sensation and shows good results in location of perception in patients with complete brachial plexus avulsion.Keywords: brachial plexus; intercostal nerves; median nerve; nerve transfer; sensation; perception. RESUMOObjetivo: A restauração da sensibilidade em pacientes com lesão completa do plexo braquial é muito importante. O objetivo desse estudo foi avaliar a recuperação sensitiva em cirurgia do plexo braquial utilizando o nervo intercostobraquial (NICB) como doador. Métodos: Onze pacientes foram submetidos a reconstrução sensitiva usando o NICB como doador para a contribuição lateral do nervo mediano, com tempo de acompanhamento pós-operatório médio de 41 meses. Um protocolo de avaliação foi realizado. Resultados: Quatro pacientes perceberam o filamento 1-verde. Os filamentos 2-azul, 3-roxo e 4-vermelho foram percebidos por um, dois e três pacientes, respectivamente. Um paciente não apresentou recuperação sensitiva. Dois pacientes obtiveram recuperação S3, dois S2+, seis S2 e um S0, pela escala de Highet. Conclusão: O procedimento usando o NICB como doador promove boa intensidade de recuperação sensitiva e bons resultados são obtidos quanto ao local de percepção em pacientes com avulsão completa do plexo braquial.Palavras-chave: plexo braquial; nervos intercostais; nervo mediano; transferência de nervo; sensação; percepção.

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Outcome of contralateral C7 transfers to different recipient nerves after global brachial plexus avulsion

et al. 2018

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IntroductionContralateral cervical seventh nerve root (CC7) transfer has been widely applied for treatment of traumatic brachial plexus injury. The purpose of the study was to evaluate outcomes of patients with global brachial plexus avulsion (GBPA) after CC7 transfer and compare the recoveries of median nerve as the only recipient nerve and one of the multiple recipient nerves.MethodsA retrospective review of 51 patients treated with CC7 transfers after GBPA was carried out. The British Medical Research Council (MRC) grading system and range of joint motion (ROM) were used for motor and sensory assessment.ResultsThe effective rates of FCR were 57.7%, 45.5%, and 36.4% in CC7 transfer to median nerve (CC7‐Md), CC7 transfer to median nerve and biceps branch (CC7‐Md+Bic) and CC7 transfer to median nerve and triceps branch (CC7‐Md+Tric) groups, respectively. There were no statistical differences no matter in FCR or FDS among groups. The effective rate in biceps had no significant difference with that in triceps. The effective sensory recovery rate was 65.4%, 54.5%, and 36.4% in CC7‐Md, CC7‐Md+Bic, and CC7‐Md+Tric groups. There were no statistical differences in the sensory effective recovery rate among groups. All the ROMs were improved significantly after surgery. The improvement of ROM of elbow flexion after surgery in CC7‐Md+Bic group was significantly larger than that of elbow extension after surgery in CC7‐Md+Tric group (p = 0.047).ConclusionsThe CC7 transfer contributed to the functional improvement of the hand and wrist for the patients with global brachial plexus avulsion. The whole CC7 could be used to repair more than one recipient nerve (including median nerve) without affecting the recovery of median nerve. When CC7 was used to repair two nerves, biceps branch might be preferred to choose as one recipient nerve rather than triceps branch.

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Outcome of contralateral C7 transfer to two recipient nerves in 22 patients with the total brachial plexus avulsion injury

Cited by 42 publications

References 33 publications

A Systematic Review of Contralateral C7 Transfer for the Treatment of Traumatic Brachial Plexus Injury

A Systematic Review of Contralateral C7 Transfer for the Treatment of Traumatic Brachial Plexus Injury

Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor

Outcome of contralateral C7 transfers to different recipient nerves after global brachial plexus avulsion

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