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Retropharyngeal Contralateral C7 Nerve Transfer to the Lower Trunk for Brachial Plexus Birth Palsy: Technique and Early Results
Anthony Vu, MD
Darlene Guse, MD
Christopher Van Belle, MD
Ann Schwentker, MD
Kevin Yakuboff, MD
University of Cincinnati
2015-03-15
Presenter: Anthony Vu, MD
Affidavit:
The resident submitting this abstract wrote a majority of the abstract and participated in all of the data collection.
Director Name: Ann Schwentker, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction:
Brachial plexus birth palsies can lead to significant long-term morbidity, even when surgical treatment is attempted. Four or five avulsed nerve roots present a particularly difficult problem for reconstruction due to the limited amount of donor nerves. The contralateral C7 nerve has been described for use as a donor nerve but mostly in adolescents and adults. Here we present our technique and early results for the retropharyngeal contralateral cross-C7 nerve transfer to the lower trunk in a series of five infants.
Methods:
A retrospective review over the past 4 years was performed. We included any infant who received a contralateral C7 nerve transfer via the retropharyngeal route to the lower trunk for brachial plexus birth palsy. Our analysis focused on hand function, complications, and donor site morbidity.
Results:
We had a total of five patients. All five patients demonstrated cortical integration of the involved hand. Sensation was present in all patients by 9 months. By 1 year, all patients had finger and thumb flexion; one patient had an AMS of 7/7 for finger and thumb flexion. No patients have had return of thumb opposition. The only complication included a hypertrophic scar of the sural nerve harvest incision. At last follow up, all five patients did not have any contralateral donor limb deficits or phrenic nerve paralysis
Conclusion:
The contralateral C7 nerve transfer via the retropharyngeal route appears to be a safe procedure in infants. Early functional recovery in our patients with regard to hand function and sensation is promising.
