Experience with direct repairs of the opposite C7 with the lower trunk has made restoration
of useful finger flexion a realistic objective in the management of total posttraumatic
brachial plexus injuries, particularly in younger individuals. This entails a detailed
exploration of the injured brachial plexus with certain essential maneuvers for proximal
mobilization of the medial cord.[1] It is based on the premise that the lower trunk is discrete and communicates with
the posterior cord via its posterior division alone. However, we have noted a distinct
contribution from the middle trunk to the lower trunk on three consecutive occasions
([Fig. 1]). Further distal dissection revealed its continuity with the medial root of the
median nerve. A similar anatomical distribution was anticipated on the uninjured side.
The fear of potential deficit in the motor territory of the median nerve following
harvest of the opposite C7 deterred us from using the technique in these three patients.
The anomalies of the middle trunk have been reported by Woźniak et al in the cadaveric
study in fetuses.[2] We communicated our observations to the original author of this technique (Dr. Shufeng
Wang)[3]
[4] who confirmed having had similar cases. However, in his experience, this branch
of the C7 continued to the lateral root of the median nerve and sectioning it did
not produce significant deficit.
Fig. 1 Contribution from the middle trunk to the medial root of the median nerve.
Our experience has been different, and we would like to stress the need for a detailed
surgical exploration of the injured plexus in each case and that the strategy for
reconstruction should be decided only on the basis of the findings.
