Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury

Because of the poor clinical results in achieving hand function in patients with complete brachial plexus root avulsion with other nerve transfers, we evaluated 111 patients prospectively to evaluate the technique of the hemi -contralateral C7 transfer to the median nerve. The transfer was performed as a primary procedure in 62 patients and as a secondary procedure in addit ional 49 patients. Twenty-one of the 62 patients in the primary group had s ufficient follow-up (at least 3 years) to assess the motor and sensory reco very in the median nerve. The adverse effects of the operation were also an alyzed in all 111 patients. Six of the 21 (29%) patients obtained M3 and 4 (19%) experienced M2 recovery of the wrist and finger flexors. Ten (48%) pa tients obtained S3 and 7 (33%) had S2 recovery in the median nerve area. Th e rate of the advancing Tinel's sign was markedly different between those a chieving M3 function and the remaining patients. Although the age of the pa tient did not correlate with outcome, patients aged 18 and younger had the best motor recovery (ie, achieving M3 function in 3 of 6 cases). There was no correlation between the timing of the surgery after the initial injury, medical comorbidities, and clinical outcome. After surgery 108 of 111 (97%) patients experienced temporary paresthesia in the median nerve area, which resolved by an average of 2.8 months. Three (3%) patients had motor weakne ss of the donor limb; this resolved completely in 2 patients and left a mil d deficit in wrist extension in 1 patient. Copyright (C) 2001 by the Americ an Society for Surgery of the Hand.