International Perspectives on Contralateral C7 Transfer for Brachial Plexus Injuries

Introduction The use of contralateral C7 (CC7) transfer for brachial plexus injury (BPI) varies considerably across geographic regions and surgical specialties. This study aimed to investigate international variation in the adoption of CC7 transfer and identify factors associated with differences in clinical practice. Methods A questionnaire was distributed to an international cohort of brachial plexus surgeons to evaluate current use of CC7 transfer, training background, practice characteristics, and factors influencing clinical decision-making. Responses were analyzed according to geographic region and surgical specialty. Results A total of 160 attending surgeons completed the survey, of whom 45.6% performed CC7 transfer. Adoption was highest in Asia and lower in Europe and the Americas. Reasons for non-use varied by region, with lack of prior exposure reported most frequently in North and South America, whereas lack of peer acceptance was more common in Europe. Adoption also varied by specialty, with use reported by 56% of orthopaedic surgeons, 53% of hand surgeons, 40% of plastic surgeons, and 30% of neurosurgeons. Prior exposure to CC7 was strongly associated with its use, although 28% of surgeons with previous exposure did not perform the procedure. Conclusion Substantial geographic and specialty-specific variation exists in the adoption of CC7 transfer. Practice patterns appear to be influenced by multiple factors, including prior exposure, perceived efficacy, peer culture, and local practice patterns. These findings provide insight into the international variation in CC7 adoption and support further investigation into the factors underlying both its use and non-use.