Five Reliable Nerve Transfers for the Treatment of Isolated Upper Extremity Nerve Injuries

Abstract

Learning Objectives: After studying this article and accompanying videos, the participant should be able to: 1. Understand and apply the principles of nerve transfer surgery for nerve injuries. 2. Discuss important considerations when performing nerve transfers, such as aspects of surgical technique and perioperative decision-making. 3. Understand indications for end-to-end versus supercharged reverse end-to-side nerve transfers. 4. Understand an algorithm for treating nerve injuries to include the indications and surgical techniques of five nerve transfers commonly performed for the treatment of isolated upper extremity nerve injuries. 5. Understand the outcomes and postoperative management of the discussed nerve transfers. Summary: Nerve transfers are gaining wide acceptance because of their superior results in the management of many nerve injuries of the upper extremity. This article presents five nerve transfers for the treatment of isolated nerve injuries in the authors' upper extremity nerve practice that offer reliable results. Indications, surgical techniques, outcomes, and postoperative management are reviewed. To maximize functional outcomes in patients with nerve injuries, the treatment should be individualized to the patient, and the principles for nerve transfers as described herein should be considered.

Brief Electrical Stimulation Promotes Recovery after Surgical Repair of Injured Peripheral Nerves

“…The C also led to superior recovery of motor and sensory function [377][378][379][380][381][382][383][384][385]. The auth pointed out that CES could be applied in delayed repair of chronic nerve injuries a major polytrauma that necessitates emergency life or limb management [Section 3], most require two consecutive surgeries for electrode placement prior to surgical rep The same issue arises in distal nerve transfer surgery where a 'donor' nerve branch o redundant muscle is cut and sutured to the distal stump of a non-functional 'recipie nerve to restore function [386][387][388][389][390][391]. Oberlin's transfer to restore elbow flexion is a clas example with a transected ulnar nerve fascicle supplying the flexor carpi ulnaris mus sutured to the distal stump of the musculocutaneous nerve branch to biceps brachii m cle [386].…”

Assessment, patient selection, and rehabilitation of nerve transfers

“…For instance, in cases of axonotmesis with axonal continuity to the target organ evidenced by 1–2 motor units on EMG or present but markedly reduced amplitude motor or sensory responses on NCS, the optimal management strategy may involve serial electrodiagnostic assessments every 1–3 months to monitor nerve recovery ( 44 ). This close follow-up permits monitoring of the trajectory of nerve recovery clinically and electrodiagnostically to increase confidence in the likelihood of satisfactory spontaneous recovery or the need for surgical intervention ( 45 ).…”

“…In addition to the insights about extent of injury, approximate localization of injury, and which nerves would benefit from transfer, EDX serves as an invaluable tool to identify suitable donor nerves. Nerve transfer requires a healthy, expendable donor nerve, which typically serves a redundant or less crucial function ( 45 , 46 ). Needle EMG can confirm the health of the donor nerve and thus its suitability for transfer.…”

Brief Electrical Stimulation Ameliorates Poor Recovery after Surgical Repair of Injured Peripheral Nerves

“…The Oberlin's transfer, as first described in 2004 [459], is the classical example. This transfer to restore elbow flexion is one of several nerve transfers [459][460][461][462][463][464][465]. It is the suture a transected ulnar nerve fascicle that had supplied the flexor carpi ulnaris muscle, to the distal stump of the musculocutaneous nerve branch to biceps brachii muscle.…”