United Brachial Plexus Network, Inc.

Now that we are back from Shriners, Scarlett will be having having surgery next month. Dr. Kozin says she needs nerve graft surgery or nerve transfer surgery. So, I'm asking parents for their personal experience/opinion on which surgery is better and why. Any information would be extremely helpful.
thanks,
Amy Browne

Daughter, Scarlett, 6 months old, LOBPI

From my understanding, they can't tell you which surgery until they go in and see what kind of damage has been done. We were hoping that my daughter would just need the nerve graft surgery, however,since her C5, C6 and C7 were completely avulsed, the only choice was nerve transfers. Hope this helps. We also had my daughter's primary surgery done in March of 2005, with Dr. Kozin. We go up for a follow up on Dec. 21st(With Dr. Kozin)

Cindy H from Alabama (I forgot to log in, sorry)

Amy,

Simply put, nerve graft usually refers to where a surgeon uses another nerve as a conduit (graft) to connect two nerves. The conduit nerve is typically the sural nerve (it is in the leg, and governs sensitivity, they are left with an small spot on the inner leg that is numb).

We usually use the term nerve graft to refer to when this conduit nerve is used to reconnect the two ends of a nerve that was ruptured - ie, to reconnect the ends which were originally conencted. When nerve surgery first started for BPI, doctors just tried to pull the ends of the nerve together and connect them that way. But, especially in OBPI, there is usually a damaged segment that must be removed, and the two ends would have to be pulled together under too much tension and would pull apart or otherwise not heal well. So they nearly always put in a conduit (graft) segment to avoid tension. There are also other options, such as using grafts to connect a ruptured nerve root to multiple spots further down the plexus. This can result in more "targeted" healing.

When we use "nerve graft" here, we usually mean that the original source is reconnected to the original downstream nerve. If the source is chosen from a new location, it is a "transfer" of source.

So a nerve transfer is when the original nerve root cannnot be connected to, usually because there is an avulsion. Say the C5 root is avulsed, but the C6 root is intact. The doctor will then connect the downstream nerves that used to be fed by C5 to the C6 root stump. This is called in intraplexus (within the plexus) transfer. Just in case the terminology wasn't confusing enough - surgeons also usually use a graft segment in order to complete the nerve transfer.

In cases where there are many avulsions, there are nerves from outside the plexus that can also be used as sources for transfer (extraplexus transfer). These might be spinal accessory nerves, part of C4, etc. The doctor has to fully explore the plexus to see what is available and then they make their best call based on experience (their own and the bulk experience of all who have been doing this) to try to make the best choices for your individual child.

Nerve surgery is a very dynamic field and with so many doctors doing so many different things, it takes a lot of sharing and discussion for the better methods to become apparent. I would trust Dr. Kozin completely to know the state-of-the art in primary surgery. You are in very good hands.

Kate

That was a great explanation Kate! Thanks! I never can seem to express myself very good. Look, I remembered to log in.