J Reconstr Microsurg 2016; 32(02): 109-113
DOI: 10.1055/s-0035-1563380
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microanatomy of the Separable Length of the C7

Ben-gang Qin
1   Department of Orthopaedic Trauma and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
,
Guo Fu
1   Department of Orthopaedic Trauma and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
,
Jian-tao Yang
1   Department of Orthopaedic Trauma and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
,
Hong-gang Wang
1   Department of Orthopaedic Trauma and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
,
Qing-tang Zhu
1   Department of Orthopaedic Trauma and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
,
Xiao-lin Liu
1   Department of Orthopaedic Trauma and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
,
Jia-kai Zhu
1   Department of Orthopaedic Trauma and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
,
Li-qiang Gu
1   Department of Orthopaedic Trauma and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
› Author Affiliations
Further Information

Publication History

30 March 2015

22 June 2015

Publication Date:
15 September 2015 (online)

Abstract

Objective The objective of this study was to provide anatomical data on modified contralateral C7 (cC7) nerve root transfers by dissecting and measuring the separable lengths of the C7 root, trunk, and divisions.

Materials and Methods Fifteen adult cervicothoracic specimens were dissected and measured using Vernier calipers after exposing the brachial plexus. Measurements included the length of the C7 from the root to the trunk, the lengths of the C7 root–trunk–anterior division (and posterior division). The epineuria at the C7 root–division–cord junctions were opened until the internal nerve bundles fused together and could not be separated by microdissection. The lengths of the C7 root–trunk–anterior (and posterior) division were measured again after microdissection. The lengths of cC7 nerve of 20 patients with bracial plexus avulsion were measured using the former technique.

Results The length of the C7 root–trunk was 45.87 SD 10.43 mm. Before separation, the lengths of the C7 root–trunk–anterior division and the root–trunk–posterior division were 61.14 SD 13.44 and 54.63 SD 11.35 mm, respectively; after separation, the lengths were 74.67 SD 12.86 and 68.73 SD 11.86 mm, respectively. The prolonged lengths were 13.15 SD 4.26 and 14.21 SD 6.98 mm, respectively. The prolonged lengths were significantly greater (p < 0.05). The prolonged length of C7 nerve clinically was anterior division, 15.30 SD 3.76 mm and posterior division, 11.10 SD 3.01 mm.

Conclusion The C7 division lengths can be prolonged by dissecting the epineuria at the division–cord junction of the C7 nerve root.

 
  • References

  • 1 Midha R. Epidemiology of brachial plexus injuries in a multitrauma population. Neurosurgery 1997; 40 (6) 1182-1188 , discussion 1188–1189
  • 2 Azze RJ, Mattar Júnior J, Ferreira MC, Starck R, Canedo AC. Extraplexual neurotization of brachial plexus. Microsurgery 1994; 15 (1) 28-32
  • 3 Brandt KE, Mackinnon SE. A technique for maximizing biceps recovery in brachial plexus reconstruction. J Hand Surg Am 1993; 18 (4) 726-733
  • 4 Brunelli G, Monini L. Direct muscular neurotization. J Hand Surg Am 1985; 10 (6 Pt 2): 993-997
  • 5 Gu YD, Zhang GM, Chen DS, Yan JG, Cheng XM, Chen L. Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion. J Hand Surg [Br] 1992; 17 (5) 518-521
  • 6 Terzis JK, Kokkalis ZT. Selective contralateral c7 transfer in posttraumatic brachial plexus injuries: a report of 56 cases. Plast Reconstr Surg 2009; 123 (3) 927-938
  • 7 Mcguiness CN, Kay SP. The prespinal route in contralateral C7 nerve root transfer for brachial plexus avulsion injuries. J Hand Surg [Br] 2002; 27 (2) 159-160
  • 8 Wang SF, Hu Q, Pan YW. Feasibility of direct anastomosis of the contralateral C7 transferred through the prespinal route of the lower trunk in patients with brachial plexus root avulsion [in Chinese]. Chinese J Pract Hand Surg 2005; 119: 67-69
  • 9 Wang SF, Li PC, Xue YH, Yiu HW, Li YC, Wang HH. Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion. J Bone Joint Surg Am 2013; 95 (9) 821-827 , S1–S2
  • 10 Wang L, Jiang Y, Lao J, Zhao X. Contralateral C7 transfer to lower trunk via the prespinal route in the repair of brachial plexus injury: an experimental study in rats. J Plast Reconstr Aesthet Surg 2014; 67 (9) 1282-1287
  • 11 Terzis JK, Kostopoulos VK. The surgical treatment of brachial plexus injuries in adults. Plast Reconstr Surg 2007; 119 (4) 73e-92e
  • 12 Terzis JK, Kokkalis ZT, Kostopoulos E. Contralateral C7 transfer in adult plexopathies. Hand Clin 2008; 24 (4) 389-400 , vi
  • 13 Waikakul S, Orapin S, Vanadurongwan V. Clinical results of contralateral C7 root neurotization to the median nerve in brachial plexus injuries with total root avulsions. J Hand Surg [Br] 1999; 24 (5) 556-560
  • 14 Chuang DC, Cheng SL, Wei FC, Wu CL, Ho YS. Clinical evaluation of C7 spinal nerve transection: 21 patients with at least 2 years' follow-up. Br J Plast Surg 1998; 51 (4) 285-290
  • 15 Tu YK, Tsai YJ, Chang CH, Su FC, Hsiao CK, Tan JS. Surgical treatment for total root avulsion type brachial plexus injuries by neurotization: a prospective comparison study between total and hemicontralateral C7 nerve root transfer. Microsurgery 2014; 34 (2) 91-101
  • 16 Tu YK, Chung KC. Surgical procedures for recovery of hand function. In: Chung KC, Yang LJS, McGillicuddy JE, eds. Practical Management of Pediatric and Adult Brachial Plexus Palsies. New York: Saunders Elsevier; 2012: 271-300
  • 17 Yu ZJ, Sui S, Yu S, Huang Y, Sheng J. Contralateral normal C7 nerve transfer after upper arm shortening for the treatment of total root avulsion of the brachial plexus: a preliminary report. Plast Reconstr Surg 2003; 111 (4) 1465-1469
  • 18 Xu L, Gu Y, Xu J, Lin S, Chen L, Lu J. Contralateral C7 transfer via the prespinal and retropharyngeal route to repair brachial plexus root avulsion: a preliminary report. Neurosurgery 2008; 63 (3) 553-558 , discussion 558–559
  • 19 Wang S, Yiu HW, Li P, Li Y, Wang H, Pan Y. Contralateral C7 nerve root transfer to neurotize the upper trunk via a modified prespinal route in repair of brachial plexus avulsion injury. Microsurgery 2012; 32 (3) 183-188
  • 20 Gu L, Xiang J, Li P , et al. Contralateral C7 nerve transfer for directly repairing brachial plexus root avulsion by prespinal route [in Chinese]. Chinese J Microsurg 2008; 31: 33-34
  • 21 Xu J, Hu S, Gu Y. Anatomic observation of human C7 nerve root and bridging ulnar nerve [in Chinese]. Chinese J Clin Anat 2000; 18: 144-145
  • 22 Wang SF, Hu Q, Wang HH , et al. The anatomical and clinical study of contralateral C7 transfer through the prespinal route [in Chinese]. Chinese J Hand Inj 2003; 19: 69-71
  • 23 Yang J, Qin B, Fu G , et al. Modified pathological classification of brachial plexus root injury and its MR imaging characteristics. J Reconstr Microsurg 2014; 30 (3) 171-178
  • 24 Lin H, Sheng J, Hou C. The effectiveness of contralateral C7 nerve root transfer for the repair of avulsed C7 nerve root in total brachial plexus injury: an experimental study in rats. J Reconstr Microsurg 2013; 29 (5) 325-330