Donor complications of contralateral C7 nerve transfer in Brachial Plexus Birth Injury: a systematic review.

PURPOSE: Contralateral C7 (CC7) nerve transfer is a reconstructive option in the upper limb when there are limited donor options. Promising results have been reported in the adult population but its role in Brachial Plexus Birth Injury (BPBI) is unclear. A major concern with this technique is the potential impact on the contralateral, unaffected limb. Our aim was to review the available literature on the use of this transfer in BPBI, to determine the incidence of short- and long-term deficits at the donor site. METHODS: The relevant literature was identified from searches of Embase, Ovid Emcare and Ovid MEDLINE, for combinations of terms relating to CC7 nerve transfer and BPBI. RESULTS: Seventy-five patients were included in this review, from the eight papers that were eligible for inclusion, from a total of 16 papers identified. Patient age ranged from three to 93 months and the shortest follow-up period was six months. Post-operative motor deficits at the donor site included reduced range of shoulder abduction; triceps weakness; and phrenic nerve palsy. All motor deficits recovered within six months. The only sensory deficit reported was reduced sensation in the median nerve distribution which, in all cases, resolved within four weeks. Finally, synchronous donor limb motion and sensation were reported in 46.6% of patients. CONCLUSION: CC7 nerve transfer in BPBI appears to have few long-term donor limb complications. Sensory and motor deficits are reportedly transient. The impact of synchronous motion and sensation on upper limb function in this patient cohort is not yet known.

Prevention and management of post-deep inferior epigastric perforator flap abdominal bulge: A 5-year single-surgeon series.

BACKGROUND: Abdominal bulge in the absence of a hernia is a known complication following free abdominal flap breast reconstruction and can be associated with significant aesthetic and functional morbidity. This study aims to review the impact of permanent subrectus mesh placement on the incidence of post-DIEP bulge. METHODS: All patients over a 5-year period who underwent unilateral or bilateral DIEP breast reconstruction were included in the study. The cohort was divided into a "permanent mesh" (PM) and "no permanent mesh" (NPM) groups. Those in the PM group underwent placement of a permanent Bard™ Soft Polypropylene Mesh, and the NPM group comprised of patients who had a semi-permanent subrectus VyproⓇ mesh or no mesh. The primary outcome of the study was the development of post-DIEP abdominal bulge or hernia. The secondary outcome was the incidence of other donor site complications such as infection. Post-operative follow-up was conducted for a minimum of 6 months. RESULTS: The study included 276 patients, 134 of whom were in the NPM group and 142 in the PM group. Demographics including mean age, median BMI, incidence of pre-operative chemotherapy, radiotherapy, and prior abdominal surgery were comparable between the two groups. The incidence of post-operative abdominal bulge or hernia was lower in the PM group (PM= 0.7% vs. NPM=5.2%, p<0.05). There was no significant difference in the incidence of donor site infection between the two groups (PM=3.5 vs. NPM=2.2%, p=0.53). CONCLUSION: Our study demonstrates that a low rate of abdominal morbidity can be achieved with the placement of a permanent subrectus mesh.