SCIENTIFIC ARTICLE Reconstruction of Pediatric Brachial Plexus Injuries With Nerve Grafts and Nerve Transfers Harvey Chim, MBBS, Michelle F. Kircher, BA, Robert J. Spinner, MD, Allen T. Bishop, MD, Alexander Y. Shin, MD Purpose To review the demographics and injury patterns in consecutive pediatric patients with traumatic brachial plexus injury presenting to a single center over a 16-year period and to review the outcomes of nerve grafting and nerve transfers for reconstruction of shoulder abduction and elbow flexion in these patients. Methods Forty-five pediatric patients presented for treatment of traumatic Brachial plexus injury from 1996 to 2012. Subgroup analysis of patients who had nerve grafting or nerve transfers for restoration of shoulder abduction and elbow flexion was carried out to compare outcomes of Medical Research Council (MRC) motor grading. Results The mean age of patients was 13.8 years (range, 3e17 y). Panplexal injuries (62%) and upper plexus injuries (16%) were particularly common. There was a very high proportion of preganglionic injuries (91%). Six of the 10 of patients who underwent intraplexal nerve grafting only for restoration of shoulder abduction achieved grade 3 or better power compared with 42% (5/12) of patients who had nerve transfers. When contralateral C7 was used as a donor for nerve transfer in restoration of shoulder abduction, 1 of the 5 patients achieved grade 3 or better shoulder abduction. All 4 patients who had nerve grafts for restoration of elbow flexion achieved grade 3 or better power, compared with 11 of 12 patients who had nerve transfers. There was no statistical difference in outcome (MRC grade 3 or 4) between patients who had nerve grafts and those who had nerve transfers. Conclusions This study shows that nerve grafts can result in similar outcomes (MRC grading) to nerve transfers for restoration of shoulder abduction and elbow flexion in traumatic pe- diatric BPI. The findings of this study do not support the use of contralateral C7 as a donor for nerve transfer in reconstruction of shoulder abduction in this age group. (J Hand Surg Am. 2014;39(9):1771e1778. Copyright Ó 2014 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV. Key words Brachial plexus injury, contralateral C7, nerve graft, nerve transfer, pediatric brachial plexus. T RAUMATIC BRACHIAL PLEXUS injuries (BPIs) in children are rare. Boome 1 reported an inci- dence of 1% of pediatric injuries out of all brachial plexus lesions in his series. Most reports consist of case series of fewer than 25 patients often accrued over 10 years or longer. 2e7 Thus, there is no consensus on the best treatment for these patients, with most surgeons adopting techniques used for adult brachial plexus reconstruction to pediatric patients. From the Department of Orthopedic Surgery, Division of Hand Surgery, and the Department of Neurosurgery, Mayo Clinic, Rochester, MN. Received for publication February 24, 2014; accepted in revised form May 22, 2014. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Alexander Y. Shin, MD, Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 1st St. South West, Rochester, MN 55905; e-mail: shin.alexander@mayo.edu. 0363-5023/14/3909-0017$36.00/0 http://dx.doi.org/10.1016/j.jhsa.2014.05.034 Ó 2014 ASSH r Published by Elsevier, Inc. All rights reserved. r 1771