C3,4 Transfer For Reconstruction Of Erb's Brachial Plexus

Branch neurotization to restore specific function of the arm is the common practice for avulsion injury of brachial plexus. We proposed the concept of "root or trunk reconstruction". As a method of "root reconstruction", we adopted C3, 4 transferring for reconstruction of C5,6 root avulsion. Anatomic, experimental studies and clinical application were conducted.In experimental Study, eighteen New Zealand rabbits were randomly divided into three groups. In group A, C3, 4 nerve roots were transferred to C5, 6 roots after avulsion with nerve graft. In group B, C5, 6 nerve roots were directly sutured after dissection. Group C was made as a negative group in which C5,6 roots were unrepaired after avulsion. All the three groups were positively controlled by contra lateral sides. Functional, anatomical, electrophysiological and histological studies were conducted postoperatively. The results showed that active motion of experimental limbs was not fond in all the three groups. Electrophysiological examination four months after operation showed that the neutrotization level of C3,4 transfer was weaker than that of direct suture. Histological study confirmed the existance of motor fibers in group A and B but C. These findings indicate that extraplexal nerve transfer indeed could re-neurotize the avulsed nerve roots down to the target organ and "root or trunk repair" for avulsion injury of brachial plexus is possible provided the donor nerve has enough fibers and nerve regeneration ability is increased by modern techniques.Based on the experimental studies, 6 patients with avulsion injuries of brachial plexus were treated by C3,4 transferring. The operating time was less than 6 months. 5 patients were followed up less than 6 months and partial sensation was restored while the motor function is in the process of recovering. One patient was followed-up for 14 months. The patients could abduct and flex his shoulder and sensation restoration was satisfactory.To facilitate the operation, we conducted anatomical study on cervical plexus. Ten fresh corpses were used in the study. We found that there were extensive communications and loops among the cervical plexus. Both motor and sensory fibers were contained in the roots. C3,4 nerve root were comparable with C5,6 in terms of diameter.