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J Reconstr Microsurg 2006; 22(4): 245-254
DOI: 10.1055/s-2006-939929
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Living-Donor Nerve Transplantation for Global Obstetric Brachial Plexus Palsy

Scott A. Gruber1 , Pedro Mancias2 , Rita D. Swinford3 , Heather R. Prashner4 , Jorge Clifton5 , Mark H. Henry5
  • 1Division of Immunology and Organ Transplantation, Department of Surgery, Houston, TX
  • 2Division of Pediatric Neurology, Department of Neurology, Houston, TX
  • 3Division of Pediatric Nephrology, Department of Pediatrics, Houston, TX
  • 4Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX
  • 5Houston Hand and Upper Extremity Center, Houston, TX
Further Information

Publication History

Accepted: January 31, 2006

Publication Date:
14 June 2006 (online)

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ABSTRACT

The first reported case of live-donor nerve transplantation is presented, performed in an 8-month-old infant with global obstetric brachial plexus palsy (OBPP) and four root avulsions who had undergone prior sural nerve autografting at 3 months. Cross-chest C7 nerve transfer and temporary tacrolimus/prednisone immunosuppression were utilized. Acute rejection was prevented, with no observable complications from the immunosuppressive medications, ipsilateral deficits resulting from the use of the contralateral C7 root as a donor nerve, or untoward effects on growth and development occurring over a 2-year follow-up period. Although some return of sensory and motor responses on nerve conduction studies was documented, the failure to observe a clinically significant functional improvement in the affected limb directly attributable to the transplant may have been due to performing the procedure too late and/or inadequate follow-up. Results of additional cases performed earlier than in this patient with longer follow-up will need to be evaluated to determine whether the procedure proves to be a viable therapeutic option for treatment of global OBPP with four or five root avulsions.

KEYWORDS

Nerve transplantation - obstetric brachial plexus palsy - contralateral C7 transfer

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Scott A GruberM.D. Ph.D. F.A.C.S. F.C.P. 

Transplant Surgery, Harper University Hospital

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