Achieving tension-free end-to-end sutures is crucial for optimal nerve recovery; however, it presents significant challenges in the contralateral C7 nerve transfer (cC7 transfer) procedure for patients with hemiplegic arms. This paper presents a modified surgical technique for cC7 transfer, featuring an aesthetically pleasing incision design. Key steps of the technique include precise incision planning, careful exposure and identification of the brachial plexus, meticulous tracing of the cC7 nerve, protection of the phrenic nerve and vertebral vessels, and the creation of a prevertebral space to facilitate the nerve transfer. We illustrate this method step by step in a hemiplegic patient. In conclusion, our approach offers a safe and effective strategy for performing modified contralateral C7 transfer surgery, ensuring tension-free end-to-end sutures for improved patient outcomes.