Introduction: Avulsion brachial plexus injuries in OBPP patients are considered as difficult to treat and are always a challenge for every reconstructive surgeon. The use of ipsilateral or contralateral C7 root represents a valuable source of motor donors in such difficult conditions. In our center the C7 root is used in a more selective manner, which means that more of C7 root elements are spared. The aim of this study is to present the results of its use as ipsilateral or contralateral motor donor.
Materials and Methods: 38 children were treated in our center, with the selective technique of ipsilateral and contralateral C7 root. In 16 of them the ipsilateral C7 (IC7) was used, while in the remaining 22 the contralateral C7 (cC7). We studied each group separately. For the clinical evaluation, the British Medical Research Council Grading System expanded with intermediate grades (i.e. M1-, M1, M1t, M2, etc.) was used. Concerning the shoulder function the modified Mallet scale was used with a grading from 1 to 4. For the hand function evaluation we used the modified Gilbert-Raimondi scale. We divided the patient population in four groups according to their denervation time (A, B, C, and D) in order to examine its impact in the outcome of our reconstructions.
Results: The overall functional restoration showed a clear improvement at a statistical significant level (p<0.05) for all targets above and below the elbow in both populations. The results were good and excellent in both groups for functional restoration above the elbow, fair and excellent in IC7 patients, and finally fair and good in CC7 patients for the reconstructions below the elbow. The only difference was found (p<0.05) for hands' extension function restoration.
No patient complained for any sensory or motor disturbance following the severance of the C7 root six months following the surgery.
Conclusion: The C7 root remains a valuable solution for OBPP avulsion injuries and with its selective use gains a very important place in the armamentarium of every reconstructive surgeon.