Living-Donor Nerve Transplantation for Global Obstetric Brachial Plexus Palsy

Scott A. Gruber; Pedro Mancias; Rita D. Swinford; Heather R. Prashner; Jorge Clifton; Mark H. Henry

doi:10.1055/s-2006-939929

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2006; 22(4): 245-254
DOI: 10.1055/s-2006-939929

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

Abstract

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

Full Text

References

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

Transplant Surgery, Harper University Hospital

3990 John R, Suite 400, Detroit, MI 48201