Contralateral C7 Transfer- Is Direct Repair Really Superior To Grafting?
Mahmoud Elsayed Salama, M.Sc orthopedics; Assuit University Hospital, Assuit, Egypt; Aakar hospital, Vadodara, Gujarat state, India; Sparsh hospital, Bengaluru, Karnataka state, India; Shah specialty hospital, Surat, Gujarat state, India; UC San Diego medical center, San Diego, CA; Dennanath Mengashkar Hospital, Pune, India
A majority of post-traumatic brachial plexus injuries are total avulsion pattern which necessitate the use of extra-plexal nerve transfers which give consistent results for the shoulder and elbow but still the hand results are poor. while the results of contralateral C7 nerve transfer for the finger and wrist flexion is inconsistent but the use of prespinal route for contralateral C7 transfer to the lower trunk has reported a higher percentage of success in recent studies.
We compared in our retrospective study the speed and the quality of reinnervation of the finger and wrist flexors after contralateral C7 nerve transfer to the lower trunk through prespinal route by direct coaptation (± humeral shortening) in one group and by short nerve graft in the other group.
22 patients with total avulsion traumatic brachial plexus injury treated by complete contralateral C7 transfer to the lower trunk through prespinal route. Direct repair of the cC7 was performed in 12 patients (in 8 of them 2.5 to 3.5 cm humeral shortening was done). In 10 patients, a direct repair was not feasible and short nerve grafting (6-10 cm) was performed. The median of follow up period was 26 (23-39) months for the direct coaptation group and 28.5(23-36) months for the nerve graft group.
10 out of the 12 cases of the direct coaptation group recorded as M3 for finger and wrist flexion and 2 as M2. The function appeared at a delay of 12-14 months from the operation with rapid progress of function without significant effort in the opposite donor limb. In the nerve graft group, only 2 out of 10 cases recorded as M3, 7 as M2 and 1 case as M0. The function appeared later (18-20 months) with slow progression and the patient had to exert significant effort in the donor limb for minimal wrist and finger flexion on the paralysed side.
Significant difference (p-value=0.008 using fisher’s exact test) in the results between the direct coaptation and short nerve grafting in contralateral C7 transfer. We feel that efforts to achieve direct approximation of the donor cC7 and the recipient lower trunk are justified and necessary. The final functional outcome of the hand needs longer follow up and further study.
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