United Brachial Plexus Network, Inc.

Hi Allison,
Grace had her surgery on the same day as Bradley for their primary and the doctor used the C-6 for her nerve graft. We were told that her C-6 was the best conductor and that was why it was chosen for the graft. I have always wondered about that too as it seems many other children had grafting done from their leg or ear. I am glad about having one less scar, but have always wondered about this particular technique.

I think we are having some confusion regarding the nerves that are used in plexus reconstruction. There are two different sets of nerves involved: the nerves that are harvested for grafts (to be essentially replacement "pipelines" between the viable end of a nerve to cross a damaged portion) and the nerves which are used as the donor nerves - the nerve roots that are still viable that are connected to the intact plexus "downstream" either directly or with grafts.

In the case of C5/C6 avulsions or severe damage, for instance, part of C4 (not usually part of the brachial plexus) is sometimes used as a donor nerve to the upper trunk of the plexus.

Sometimes the chosen donor nerves are long enough that you don't need additional lengths of nerve sheath from the sural nerves in the leg or the facial nerve. For example, if C4 is being used a long enough length can be dissected out so additional graft material isn't needed to connect the C4 nerve root to the intact part of the plexus.

In addition, in upper trunk injuries, sometimes either C5 or C6 is less damaged, and the surgeon will graft primarily or completely to the more viable donor nerve root. Karen... it sounds like in your child's case your doctor chose C6 as the donor nerve to connect to(and left out C5 since C6 had greater conductivity). Perhaps they didn't need to use extra graft material (from the leg) because C6 was long enough or there wasn't a big distance to cross to reach undamaged nerve? I don't think they meant that they used C6 as the graft material to connect the other nerves back together, but I could be mistaken.

Here's an interesting site on the details of two complicated primary surgeries which dealt with avulsions of the upper trunk (two cases are described at the bottom which include grafting to C4 for avulsions of C5):

http://brachialplexus.wustl.edu/neurosurgical0.html

Kate