Nerve transfer in the management of upper extremity paralysis after brachial plexus and central neurologic injuries: Experience of Huashan

Abstract

Huashan Hospital receives the largest population of brachial plexus injury patients in China. Here, we presented our latest follow-up cases and newest strategies of nerve transfer in different types of brachial plexus injury, including both supra- and infra-clavicular injuries. The most challenging brachial plexus avulsion injuries (BPAI) involving partial (upper/lower) or global plexus will be mainly discussed. We will focus on optimized combination of nerve transfer strategies for perusing the best outcomes, especially the distal functions. In partial brachial plexus injury patients, several intra-brachial plexus donor nerves are utilized, such as brachialis branch of the musculocutaneous nerve, superior motor branch of the median nerve, partial ipsilateral C7 nerve. The extended applications of contralateral C7 nerve transfer and full-length phrenic nerve transfer will be specifically introduced. Moreover, special brachial plexus injury types with non-classical nerve transfer surgery are also included. As the central nervous system plays an important part in the rehabilitation process of peripheral nerve injury, we further explored the relationship between brachial plexus injury-repair (transfer) and brain reorganization. Based on our previous researches, the contralateral C7 nerve transfer shows the capacity of inducing the compensation potential of the intact hemisphere after unilateral central neurologic injury (e.g. cerebral palsy, traumatic brain injury, stroke). The contralateral C7 nerve transfer was thus used in treating hemiplegic upper extremities and applied in more than 50 patients. The preliminary results of these cases will also be presented.