Objective: To assess the safety and efficacy of total contralateral (7 transfer with vascularized folded ulnar nerve graft passed through the subclavicular and pretracheal tunnel in repair of total brachial plexus root avulsion and rupture. Subject and method: 110 patients with brachial plexus injury due to total root avulsion and rupture were treated with total contralateral (7 transfer to the musculocutaneous and median nerves. There were some changes in surgical techniques: 1- The nerve grafts were passed through the subclavicular and pretracheal tunnel
2- The vascularized folded ulnar nerve graft were used. Result: Two patients had a complication of temporary phrenic nerve palsy. The motor recovery of elbow, wrist and finger flexors reached or = M3 in 88.2 percent, 29 percent and 21 percent of patients, respectively. Sensory recovery on the hand reached or = 52 in 95.4 percent. Conclusion: The total contralateral C7 transfer with vascularized folded ulnar nerve graft passed through the subclavicular and pretracheal tunnel to repair total brachial plexus root avulsion and rupture was a safe surgery and could help to reduce the length of nerve grafts. The functional recovery of the recipient nerves was satisfactory.