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Background <p>Contralateral seventh cervical nerve (CC7) cross transfer restores upper limb function in hemiplegia after brain injury. As a cervical procedure involving dissection near major lymphatic structures, CC7 transfer carries a potential risk of lymphatic leakage, a complication well described in other neck surgeries but not systematically studied in this context.</p> Methods <p>This study aims to evaluate lymphatic leakage after CC7 transfer through a combined clinical analysis and cadaveric anatomical study. We retrospectively reviewed 507 patients who underwent CC7 transfer from May 2023 to December 2024. In parallel, we also dissected cadavers to measure the diameters of major lymphatic trunks, as well as the distance from the thoracic duct termination to the lower trunk of the brachial plexus.</p> Results <p>Lymphatic leakage occurred in 14 of 507 patients (2.8%), predominantly on left-side (11/14), and was typically observed within 72&#xa0;h. All cases were low-output, resolving with conservative treatment—namely pressure dressings and dietary modification—without the need for reoperation. The only impact was a prolonged duration of drainage. Cadaver dissections (<i>n</i> = 4) showed that the thoracic duct terminated at the venous angle, at a distance of more than 20&#xa0;mm from the lower trunk of the brachial plexus. The jugular lymphatic trunks were consistently slender (&lt; 1.5&#xa0;mm).</p> Conclusion <p>Lymphatic leakage after CC7 transfer is a rare (2.8%) and manageable complication that can be effectively managed with conservative measures. Descriptive cadaveric observations suggest that major thoracic duct transection may be less likely during standard CC7 exposure​ given the measured distance (&gt; 20&#xa0;mm) from the brachial plexus. However, care is warranted during left-sided coaptation medial to the anterior scalene muscle.</p> Type of study/level of evidence <p>This study provides Level III evidence from retrospective cohort analysis, complemented by Level V evidence from cadaveric anatomical investigation.</p>

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Low-output lymphatic leakage after contralateral seventh cervical nerve cross transfer: a clinical and anatomical observation

  • 期刊论文

  • 发表日期：

    2026年1月30日

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  • Siyuan Zhu,
  • Ying Liu,
  • Xiaozhen Zhang,
  • Ye Xu,
  • Xiaoqian Wang,
  • Pin Pan,
  • Chenglong Zhao,
  • Yanqun Qiu,
  • Wendong Xu

摘要

Background

Contralateral seventh cervical nerve (CC7) cross transfer restores upper limb function in hemiplegia after brain injury. As a cervical procedure involving dissection near major lymphatic structures, CC7 transfer carries a potential risk of lymphatic leakage, a complication well described in other neck surgeries but not systematically studied in this context.

Methods

This study aims to evaluate lymphatic leakage after CC7 transfer through a combined clinical analysis and cadaveric anatomical study. We retrospectively reviewed 507 patients who underwent CC7 transfer from May 2023 to December 2024. In parallel, we also dissected cadavers to measure the diameters of major lymphatic trunks, as well as the distance from the thoracic duct termination to the lower trunk of the brachial plexus.

Results

Lymphatic leakage occurred in 14 of 507 patients (2.8%), predominantly on left-side (11/14), and was typically observed within 72 h. All cases were low-output, resolving with conservative treatment—namely pressure dressings and dietary modification—without the need for reoperation. The only impact was a prolonged duration of drainage. Cadaver dissections (n = 4) showed that the thoracic duct terminated at the venous angle, at a distance of more than 20 mm from the lower trunk of the brachial plexus. The jugular lymphatic trunks were consistently slender (< 1.5 mm).

Conclusion

Lymphatic leakage after CC7 transfer is a rare (2.8%) and manageable complication that can be effectively managed with conservative measures. Descriptive cadaveric observations suggest that major thoracic duct transection may be less likely during standard CC7 exposure​ given the measured distance (> 20 mm) from the brachial plexus. However, care is warranted during left-sided coaptation medial to the anterior scalene muscle.

Type of study/level of evidence

This study provides Level III evidence from retrospective cohort analysis, complemented by Level V evidence from cadaveric anatomical investigation.