Combined Nerve and Tendon Transfers for C7-T1 Brachial Plexus Avulsion Injury.

Background: In patients with C7-T1 brachial plexus avulsions, complete loss of hand function is commonly seen. However, the reconstruction of hand function is difficult.
Objective: To report the outcomes of hand function recovery after combined nerve and tendon transfers in C7-T1 brachial plexus injury.
Methods: From 2012 to 2019, 8 patients with C7-T1 brachial plexus injury underwent combined nerve and tendon transfers for hand function restoration, which included the following: (1) the pronator teres motor branch to the anterior interosseous nerve and brachialis motor branch to the flexor digitorum superficialis branch for finger flexion, (2) the supinator motor branch to the posterior interosseous nerve for finger extension, (3) the brachioradialis tendon transfer for thumb opposition, and (4) the radial branch of the superficial radial nerve to the sensory branch of the ulnar nerve for sensory reconstruction. Patients were evaluated for functional improvement of finger flexion, finger extension, thumb opposition, and sensory recovery.
Results: No clinical donor deficits were observed. Seven of eight patients recovered finger and thumb flexion (4 patients scored British Medical Research Council grade M4 and 3 scored M3). The average grip strength was 3.4 kg. All patients regained finger extension (4 scored M4 and 4 scored M3), thumb opposition, and protective sensation on the ulnar hand. Patients were able to use their reconstructed hands in daily lives.
Conclusion: Combined nerve and tendon transfers are reliable and effective. This strategy could be an option for hand function reconstruction after C7-T1 brachial plexus injury.
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