Contralateral C_7 transfer to two recipient nerves at the same time:preliminary clinical report

Objective To investigate how to make better use of the abundant nerve fibers of C_7 to neurotize more recipient nerves and restore more function. Methods Based on the traditional procedure, we designed a new surgical procudure to improve the functional results after contralateral C_7 transfer. In one procedure (5 cases) the ulnar nerve was splited and sutured to the median nerve and the radial nerve or the musculocutaneous nerve by end-to-end neurorraphy. In the other procedure (3 cases) C_7 was transfer via ulnar and sural nerve graft to neurotize two recipient nerves. Results 4 patients of procedure one and patient of procedure 2 had sufficient follow-up with a follow- up period from 12 months to 19 months.Motor functions of the median nerve showed that the flexion of wrist and fingers reached M_3 in 2 of 4 patients, M_2 in another 2 cases. Sensation of the median nerve was S_2 in 3 cases and S0 in 1. Two of 4 patients obtained M_2 in wrist and finger extensors. One patient had elbow extensor M_2 and wrist extensors M_1. One patient obtained S_2 in radial nerve innervated area, 1 patient had S_1, and 2 patients had So. For the patient with C_7 transfer via ulnar and sural nerve graft to neurotize median nerve and musculocutaneous nerve, M_3 recovery of the wrist and finger flexors and M_3 recovery of the elbow flexors were seen at 13 months after the operation. In this case, the sensation of the median nerve was S_2. Another 3 cases were in progress of follow-up due to the short postoperative period. Conclusion Contralateral C_7 transfer to two major recipient nerves is an efficient method for treatment of root avulsion of brachial plexus when the donor nerve is limited.