Introduction: The use of selective ipsilateral or contralateral C7 technique represents a valuable source of motor donor in severe obstetrical brachial plexus palsies (OBPP). Our experience with this technique and analysis of the outcomes will be presented.

Materials and Methods: 39 children were treated in our center with the selective ipsilateral and contralateral C7 technique. In 17 of them the ipsilateral C7 (IC7) was used, while the remaining 22 had contralateral C7 (cC7). Each group was studied separately. Evaluation of results involved the British Medical Research Council Grading System expanded with intermediate grades (i.e. M1-, M1, M1+, M2, etc); A Poor result was M0 to M2; A Fair result was M2+ to M3; Good M3+ to M4-; and Excellent M4 to M5-. Shoulder function was evaluated by the modified Mallet scale with a grading from 1 to 4. Hand function was assessed by the modified Gilbert-Raimondi scale.

Results: The overall functional restoration showed a clear improvement at a statistical significant level (p<0.05) for all the targets above and below the elbow in both populations. IC7 population concerning the targets above the elbow we had 71.4% of excellent results for deltoid restoration, 70% of excellent results for biceps, and 61.5% of excellent results for triceps. In the cC7 population for the same targets we had 25% excellent and 25% of good results for deltoid restoration, 66.67% of excellent results for biceps, and finally 40% of excellent and 30% of good results for triceps. For the targets below the elbow in the IC7 population we had 66.7% of excellent results for finger flexion and 50% for finger extension. In the cC7 population we had 57.15% of good and fair results for finger flexion and 49.3% for finger extension. Concerning the shoulder functional restoration as measured by the Mallet scale, all functions in both groups (IC7 and cC7) were improved at a statistically significant level (p<0.05).

Conclusion: The use of the C7 root remains a valuable solution for severe obstetrical brachial plexus injuries and the selective IC7 and cC7 technique allows the rational reinnervation of anterior and posterior targets from similar motor donor pools, which facilitates rehabilitation of the reconstructed patient.
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