title: Restoration of hand function in C7-T1 brachial plexus palsies using a staged approach with nerve and tendon transfer.
abstract: Brachial plexus palsies of C7-T1 result in the complete loss of hand function, including finger and thumb flexion and extension as well as intrinsic muscle function. The task of reanimating such a hand remains challenging, and so far there has been no reliable neurological reconstructive method for restoring hand function. The authors aimed to establish a reliable strategy to reanimate the paralyzed hand. Two patients had sustained C7-T1 complete lesions. In the first stage of the operative procedure, a supinator motor branch to posterior interosseous nerve transfer was performed with brachialis motor branch transfer to the median nerve to restore finger and thumb extension and flexion. In the second stage, the intact brachioradialis muscle was used for abductorplasty to restore thumb opposition. Both patients regained good finger extension and flexion. Thumb opposition was also attained, and overall hand function was satisfactory. The described strategy proved effective and reliable in restoring hand function after C7-T1 brachial plexus palsies.
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University Medical Center;
authors.forename: Cheng-Gang
authors.initials: CG
authors.lastname: Zhang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Dong
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Gu
mesh_terms: D000293:Adolescent; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D005385:Fingers / Q000502:physiology; D006225:Hand / Q000502:physiology* / Q000601:surgery*; D006732:Horner Syndrome / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D009460:Neurologic Examination; D010243:Paralysis / Q000601:surgery*; D020127:Recovery of Function; D013709:Tendon Transfer / Q000379:methods*; D013933:Thumb / Q000502:physiology; D016896:Treatment Outcome
keywords: AIN = anterior interosseous nerve; PIN = posterior interosseous nerve; brachial plexus; hand reconstruction; lower brachial plexus; nerve transfer; neurotization; peripheral nerve; tendon transfer