Reinnervation, Hand Function

Results in Complete Paralysis

The repair of complete paralysis has always been a challenge .
For more than 40 years , attemps of repair of the lower trunk have never given consistant results . The classical repairs with grafts and local neurotizations (intercostals) do not a lead to a regular recovery of the hand ;
In our experience of 630 complete paralyses operated , only 20% had a five-roots avulsion .These are , of course the most difficult cases .
From these cases , 200 had and attempt to repair the lower trunk , usually through grafts from the upper roots . Only 22% had some fingers flexion . The repair of the lower roots has such a bad reputation that many surgeons prefer to use all the good uppers roots available to repair the shoulder and elbow and abandon the hand , in the hope of some further surgery later ( muscle transfers).
The occurrence of the contralateral C7 transfer has raised hopes to improve those results . However , the results of CLC7 transfer by classical means ( subcutaneous graft ) have not proven to largely modify the results . Bathia has recently shown that this technique gave him approximately 40% of positive results : a non decicive improvement . Tu , using vascularized nerve graft obtained 65% recovery of the hand .
The great breakthrough came when Wang improved the technique , using the prespinal root and with a direct suture at all costs between C7 and the lower trunk ( even when needed , shortening of the humerus ) . He added systematically a neurotization of the posterior trunk by the phrenic nerve . Not only 72% of the patients have wrist flexion , 64% fingers flexion , but they have recovery of a good overall use of the arm . We visited the patients and were impressed by their results.
This is why , since beginning of 2013 , we have started to use the procedure , as long as the patient is willing and accept the potential drawbacks

The best result obtained with classical treatment ( grafts + neurotizations)

Result on the hand with C7 transfer ( Wang technique)

Results in upper palsy

In upper palsy ( C5-C6 and C5-C6-C7) , the results are good . With grafts , our results of C5-C6 reconstruction show 66% of good results in the shoulder , 78% of good results in Elbow flexion .

Avulsion injuries of C5-C6 used to be very difficult to repair with poor results . Since the use of neurotizations , the results have been widely improved : with neurotizations , our results are 80% of good results in the shoulder and 90% of good elbow flexion .