Did the partial contralateral C7-transfer fulfil our expectations? Results after 5 year experience.

OBJECTIVE: Within the last decade contralateral C7-transfer has become a new source of axon donor in complete brachial plexus lesions.

METHODS: Ten adult patients with a complete posttraumatic brachial plexus lesion and a follow-up of more than 5 years are analyzed. As shown by GU we are using a two stage procedure with exploration and extraplexuel neurotization of the suprascapular nerve using 1/2 spinal acessory nerve. Depending on the intraoperative findings, the musculocutaneous nerve is neurotized by the phrenic nerve at the time of primary operation or secondarily neurotized by the contralateral C7 root. If the musculocutaneous nerve could be neurotized by the phrenic nerve, C7-transfer is used to reinnervate the median nerve. If ever possible, the vascularized ulnar nerve graft or if not availabe two sural nerves are used. Neurotization of the musculocutaneous nerve was carried out in 6, and of the median nerve in 4 patients. There are 6 patients in the MC group and 4 patients in the Median group. Criterias for evaluation used are: donor site (morbidity, classification), time for recovery, time for autonomization, and functional result. Successful elbow flexion is achieved if muscle power > M3, successful median nerve motor function is achieved if a primitive power grip pattern is achieved.

RESULTS: All patients were complaining of temporary paresthesia in the dorsal part of P3 of the thumb, index and middle finger. There was complete sensory at the 3-month postoperative examination. There was no evident clinical motor loss at the donor extremity. A successful elbow flexion, i.e. muscle power > M3 was achieved in all 6 patients after 9-15 months. 4 of 6 patients are able to use this function individually. In the other two patients a start command must be given voluntarily from the contralateral side (contraction of the contralateral latissimus dorsi muscle). A functional primitive grip pattern could be achieved in 1 out of 4 patients after 18 months. In three patients, although there is movement, this mouvement must be judged "academic" at the present state.

CONCLUSIONS: The C7-transfer proved to be a safe transfer if at the time of operation no fascicles innervating wrist and finger extension are taken. Provided adequate biceps muscle organ function, active elbow flexion can be reconstructed in most of the patients. However, for median nerve reinnervation motor results are moderate up to now.