Tuesday, February 6, 2007

Contralateral C7 Transfer for the Treatment of Brachial Plexus Root Avulsions in Children-A Report of 12 Cases.

(J Hand Surg [Am]. 2007 Jan;32(1):96-103)

Abtract: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17218182&query_hl=5&itool=pubmed_docsum

1 comment:

Coordinator said...

These authors report a heterogenous case series of 12 babies and children with quite severe brachial plexus injuries that underwent contralateral (complete) C7 transfer using either conventional cutaneous nerve grafts or a rotational, vascularized ulnar nerve graft. The median age was 17 months, median delay until surgery was 7 months, and average follow-up of 42 months. These authors have pioneered this technique and have extensive experience. They compare their results with those found in adults.

Overall, their results with this technique was better than what is seen in adults: 10/12 children recovered at least partial function against gravity (M2+), even when surgery was delayed beyond one year (especially for arm flexion). Furthermore, conventional cutaneous nerve grafts from contralateral C7 to the the proximal brachial plexus showed a good result in 3 patients, which is not usually the case with adults, where non-vascularized grafts from C7 are avoided. These outcomes may reflect the shorter graft lengths required, or a child's likely greater potential for regeneration or cortical plasticity. Of interest, no median nerve innervated hand intrinsic muscles recovered when the ulnar graft was coapted to the whole, or medial, portion of the median nerve.

A curious morbidity occurred in the donor limb of 2 patients: they had significant shoulder abduction (and flexion?) weakness (movement to about 75 degrees), which resolved at 2-3 weeks. The authors report neurophysiological testing was negative (as expected this soon after surgery), and theorize that perhaps it was from C7 contribution to the deltoid. One can also speculate it may be secondary to serratus anterior denervation (I guess possible), or perhaps it was related to incisional pain (unlikely)?