Introduction: High disability present in traumatic brachial
plexus palsy with total nerve root avulsion, as nothing left
for intra plexus repair. Nerve transfer from nearby donors has
a disadvantage of having a low number of myelinated fibers
to innervate totally avulsed plexus. Using cross C7 (CC7)
could add more donor myelinated fibers to solve this problem.
The Aim of Study: Is to assess the safety of pre-vertebral
approach (retro-esophageal) in comparison with a subcutaneous
tunnel by using vascularized ulnar nerve graft (VUNG).
Patients and Methods: Nineteen patients with total nerve
root avulsion were divided according to the operative procedure
into two groups: Prevertebral approach for turned on cross
C7 (group I), and subcutaneous tunnel with VUNG (group < br />II).
Results: No significance difference could be detected
between group I and group II regarding the mean value of
shoulder motor recovery, elbow motor recovery, hand motor
recovery, hand sensation, or follow-up period. However, the
duration of surgery in group I was significantly lower and the
hospital stay was significantly shorter than that of group II.
Moreover, the incidence postoperative complications were
higher in group II.
In Conclusion: Cross C7 can be done through subcutaneous
approach with VUNG or through pre-vertebral retroesophageal
approach. Pre-spinal retro-esophageal approach
is safer, easy, and protected tunnel for CC7 transfer to lower
plexus avulsion neuritization.