A Systematic Review of Outcomes of Contralateral C7 Transfer for the Treatment of Traumatic Brachial Plexus Injury: Part 2. Donor-Site Morbidity.

BACKGROUND: Although contralateral C7 (CC7) transfer has been widely used for treating traumatic brachial plexus injury, the safety of the procedure is questionable. The authors performed a systematic review to investigate the donor-site morbidity, including sensory abnormality and motor deficit, to guide clinical decision-making.

METHODS: A systematic review on (CC7) transfer for traumatic brachial plexus injury was performed for original articles in the PubMed and Embase databases. Patient demographic data and donor-site morbidity of (CC7) transfer, including incidence, recovery rate, and recovery time were extracted. The sensory abnormality areas and muscles involved in motor weakness were also summarized.

RESULTS: A total of 904 patients from 27 studies were reviewed. Overall, 74 percent of patients (668 of 897) experienced sensory abnormalities, and 98 percent (618 of 633) recovered to normal; the mean recovery time was 3 months. For motor function, 20 percent (118 of 592) had motor deficit after (CC7) transfer and 91 percent (107 of 117) regained normal motor function; the mean recovery time was 6 months. Sensory abnormality mainly occurred in the area of the hand innervated by the median nerve, whereas motor deficit most often involved muscles innervated by the radial nerve. There were 19 patients with long-term morbidity of the donor site in the studies.

CONCLUSIONS: The incidence of donor-site morbidity after (CC7) transfer was relatively high, and severe and long-term defects occurred occasionally. (CC7) transfer should be indicated only when other donor nerves are not available, and with a comprehensive knowledge of the potential risks.