Liu Yuzhou, Yu Hu, Liu Jingbo, Lao Jie
From the Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
NHC Key Laboratory of Hand Reconstruction, Fudan University, Shanghai, China.
Plast Reconstr Surg Glob Open. 2025 Sep 24;13(9):e7066. doi: 10.1097/GOX.0000000000007066. eCollection 2025 Sep.
Due to the possibility of intrinsic muscle recovery, we modified the traditional contralateral cervical seventh (CC7) nerve transfer to repair both the median nerve and deep branch of the ulnar nerve (DBUN) for patients with total brachial plexus avulsion (TBPA).
A retrospective comparative study of different CC7 transfers for patients with TBPA was carried out. The modified group (20 patients) had CC7 transfer to the median nerve and DBUN by ulnar nerve with vascular pedicle and medial antebrachial cutaneous nerve. The control group (20 patients) had traditional CC7 transfer to median nerve by ulnar nerve with vascular pedicle.
Motor unit potentials (MUPs) could be recorded in the abductor digiti minimi (ADM) and dorsal interosseous muscle in 5 and 2 patients, respectively, in the modified group, whereas nobody had MUP in the ADM or dorsal interosseous muscle in the control group. There was significant difference between the 2 groups in the recovery of MUPs in ADM. As for median nerve recovery, there were no statistical differences in the positive rates of MUPs in abductor pollicis brevis. No significant differences of compound motor action potential existed in flexor digitorum profundus of index finger or flexor carpi radialis between the 2 groups.
From the perspective of electrophysiology, it was possible to regenerate intrinsic muscles using CC7 transfer to the median nerve and DBUN by pedicled ulnar nerve and medial antebrachial cutaneous nerve in patients with TBPA while not affecting the recovery of the median nerve.
由于内在肌肉恢复的可能性，我们对传统的对侧颈7（CC7）神经移位术进行了改良，用于修复全臂丛神经撕脱伤（TBPA）患者的正中神经和尺神经深支（DBUN）。
对TBPA患者不同CC7移位术进行回顾性比较研究。改良组（20例患者）采用带血管蒂尺神经和前臂内侧皮神经将CC7移位至正中神经和DBUN。对照组（20例患者）采用带血管蒂尺神经将传统CC7移位至正中神经。
改良组分别有5例和2例患者在小指展肌（ADM）和骨间背侧肌可记录到运动单位电位（MUP），而对照组在ADM或骨间背侧肌均未记录到MUP。两组在ADM的MUP恢复情况上存在显著差异。至于正中神经恢复情况，拇短展肌MUP阳性率两组间无统计学差异。两组示指深屈肌或桡侧腕屈肌的复合运动动作电位无显著差异。
从电生理学角度看，对于TBPA患者，采用带蒂尺神经和前臂内侧皮神经将CC7移位至正中神经和DBUN来再生内在肌肉是可行的，且不影响正中神经的恢复。
