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Zhu S, Ye X, Feng JT, Li T, Yin HW, Qiu YQ, Xu WD, Shen YD. Cadaveric Feasibility Study on Modified Contralateral C7 Nerve Transfer for Targeted Recovery in Hemiplegic Arms. Plast Reconstr Surg 2024; 154:802-810. [PMID: 37921616 DOI: 10.1097/prs.0000000000011178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Contralateral cervical seventh (cC7) nerve to C7 transfer has been proven effective for treating spastic upper limb. However, for those whose major impairment is not in the C7 area, cC7 nerve transfer to other nerves may achieve a better outcome. The aim of this study was to explore the optimal surgical approach for transferring cC7 to 1 or 2 nerves in a cadaveric study, and to evaluate possible applications for patients with hemiplegia. METHODS Modified cC7 transfer to 1 (5 procedures) or 2 nonadjacent (3 procedures) nerve roots was proposed, and success rates of direct coaptation through 2 surgical approaches-the superficial surface of longus colli (sLC) and the deep surface of longus colli (dLC) approach-were compared. The length, diameter, and distance of relevant nerves were also measured in 25 cadavers. RESULTS Compared with the sLC approach, the distance of the dLC approach was 1.1 ± 0.3 cm shorter. The success rates for the sLC and dLC approaches were as follows: cC7 to C5 surgery, 94%, and reached 98%; cC7 to C6 surgery, 54% and 96%; cC7 to C7 surgery, 42% and 94%; cC7 to C8 surgery, 34% and 94%; cC7 to T1 surgery, 24% and 62%; cC7 to C5C7 surgery, 74% and 98%; cC7 to C6C8 surgery, 54% and 98%; and cC7 to C7T1 surgery, 42% and 88%. CONCLUSIONS The dLC approach greatly improved the direct coaptation rate for cC7 nerve transfer. The modified cC7 nerve transfer procedures are technically feasible for further application in clinic.
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Affiliation(s)
- Shuai Zhu
- From the Department of Hand Surgery, Huashan Hospital, Fudan University
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital
| | - Xuan Ye
- Department of Thyroid and Breast Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | - Jun-Tao Feng
- From the Department of Hand Surgery, Huashan Hospital, Fudan University
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital
- National Clinical Research Center for Aging and Medicine, Huashan Hospital
- NHC Key Laboratory of Hand Reconstruction, Fudan University
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
| | - Tie Li
- From the Department of Hand Surgery, Huashan Hospital, Fudan University
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital
- National Clinical Research Center for Aging and Medicine, Huashan Hospital
- NHC Key Laboratory of Hand Reconstruction, Fudan University
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
| | - Hua-Wei Yin
- From the Department of Hand Surgery, Huashan Hospital, Fudan University
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital
- National Clinical Research Center for Aging and Medicine, Huashan Hospital
- NHC Key Laboratory of Hand Reconstruction, Fudan University
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
| | - Yan-Qun Qiu
- From the Department of Hand Surgery, Huashan Hospital, Fudan University
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital
- National Clinical Research Center for Aging and Medicine, Huashan Hospital
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
| | - Wen-Dong Xu
- From the Department of Hand Surgery, Huashan Hospital, Fudan University
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital
- National Clinical Research Center for Aging and Medicine, Huashan Hospital
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
| | - Yun-Dong Shen
- From the Department of Hand Surgery, Huashan Hospital, Fudan University
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital
- National Clinical Research Center for Aging and Medicine, Huashan Hospital
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
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Feng J, Li T, Lv M, Kim S, Shin JH, Zhao N, Chen Q, Gong Y, Sun Y, Zhao Z, Zhu N, Cao J, Fang W, Chen B, Zheng S, Xu Z, Jin X, Shen Y, Qiu Y, Yin H, Jiang S, Li J, Ying Y, Chen L, Liu Y, Jia J, Zuo C, Xu J, Gu Y, Xu W. Reconstruction of paralyzed arm function in patients with hemiplegia through contralateral seventh cervical nerve cross transfer: a multicenter study and real-world practice guidance. EClinicalMedicine 2022; 43:101258. [PMID: 35028546 PMCID: PMC8741478 DOI: 10.1016/j.eclinm.2021.101258] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A previous randomized controlled trial showed contralateral seventh cervical nerve (CC7) cross transfer to be safe and effective in restoring the arm function of spastic arm paralysis patients in a specified population. Guidance on indications, safety and expected long-term improvements of the surgery are needed for clinical practice. METHODS This is a retrospective, multicenter, propensity score-matched cohort study. All patients registered between 2013 and 2019 with unilateral spastic arm paralysis over 1 year who were registered at one of five centers in China and South Korea were included. Patients received CC7 cross transfer or rehabilitation treatment in each center. Primary outcome was the change in the upper-extremity Fugl-Meyer (UEFM) score from baseline to 2-year follow-up; larger increase indicated better functional improvements. FINDINGS The analysis included 425 eligible patients. After propensity score matching, 336 patients who were 1:1 matched into surgery and rehabilitation groups. Compared to previous trial, patient population was expanded on age (< 12 and > 45 years old), duration of disease (< 5 years) and severity of paralysis (severe disabled patients with UEFM < 20 points). In matched patients, the overall increases of UEFM score from preoperative evaluation to 2-year follow-up were 15.14 in the surgery group and 2.35 in the rehabilitation group (difference, 12.79; 95% CI: 12.02-13.56, p < 0.001). This increase was 16.58 at 3-year and 18.42 at 5-year follow-up compared with the surgery group baseline. Subgroup analysis revealed substantial increase on UEFM score in each subgroup of age, duration of disease, severity of paralysis and cause of injury. No severe complication or disabling sequela were reported in the surgery group. INTERPRETATION This study showed that CC7 cross transfer can provide effective, safe and stable functional improvements in long-term follow-up, and provided evidences for expanding the indications of the surgery to a wider population of patients with hemiplegia.
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Affiliation(s)
- Juntao Feng
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Tie Li
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Center of Evidence-Based Medicine, Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Sangsoo Kim
- Kim Sang Soo Microclinic, Seoul, South Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea
| | - Naiqing Zhao
- Center of Evidence-Based Medicine, Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Qingzhong Chen
- Department of Hand Surgery, Department of Rehabilitation, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China
| | - Yanpei Gong
- Department of Hand Surgery, Department of Rehabilitation, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China
| | - Yucheng Sun
- Department of Hand Surgery, Department of Rehabilitation, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China
| | - Zaixing Zhao
- Department of Handsurgery, Department of Neurology, Ningxia Hui Autonomous Region Wujingzong Hospital, Yinchuan, China
| | - Ning Zhu
- Department of rehabilitation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jihua Cao
- Department of Handsurgery, Department of Neurology, Ningxia Hui Autonomous Region Wujingzong Hospital, Yinchuan, China
| | - Wen Fang
- Department of rehabilitation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Bin Chen
- Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Song Zheng
- Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhu Xu
- Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xin Jin
- Department of Orthopedics, Department of Rehabilitation, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yundong Shen
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Yanqun Qiu
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Huawei Yin
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Su Jiang
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Jie Li
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Ying Ying
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Liwen Chen
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Ying Liu
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Chuntao Zuo
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianguang Xu
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
| | - Yudong Gu
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Wendong Xu
- The National Clinical Research Center for Aging and Medicine, Center for the Reconstruction of Limb Function, Hand Surgery department, Rehabilitation department, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Department of Rehabilitation, Jing'an District Central Hospital, Fudan University, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Shanghai, China
- State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center of Brain Science, Department of Anatomy and Histology and Embryology, Institutes of Brain Science, Fudan University, Shanghai, China
- Corresponding author at: The National Clinical Research Center for Aging and Medicine, Hand Surgery Department, Jing'an District Central Hospital, Huashan Hospital, Fudan University, Shanghai, China.
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