J Korean Soc Surg Hand.  2017 Sep;22(3):154-164. 10.12790/jkssh.2017.22.3.154.

Nerve Transfer to Restore Upper Extremity Function

• Lee SH
• Lee YH

• KMID: 2391212
• DOI: http://doi.org/10.12790/jkssh.2017.22.3.154

Abstract

The term "˜Nerve Transfer' means the transfer of a normal or nearly normal fascicle or nerve branch to an important sensory or motor nerve that has sustained irreparable proximal damage. It is a kind of salvage procedure performed when the proximal part of a peripheral nerve is totally damaged and impossible to be repaired. In case of irreparable preganglionic injury, it is difficult to recovery the nerve function by only nerve graft. In this case, the uninjured nerve around the brachial plexus could be transferred to restore the function of the upper extremities. Previous studies have reported a high recovery rate for the function of the upper limb above the elbow and recent efforts have been made to restore the function of the upper limb below the elbow including hand functions. The purpose of this article is to review the type of nerve transfer to restore upper extremity function, operative technique, outcomes and complication.

Keyword

Brachial plexus; Nerve transfer; Neurotization; Reconstruction of upper extremity

MeSH Terms

Brachial Plexus
Elbow
Hand
Nerve Transfer*
Peripheral Nerves
Transplants
Upper Extremity*

Figure

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  Fig. 1 Spinal accessory nerve transfer (distal motor branch) to suprascapular nerve for the patients with suprascapular nerve palsy due to brachial plexus injury. (A) Distal motor branch of spinal accessory nerve. Inferior loop (white arrow), distal motor branch of spinal accessory nerve; superior loop (yellow arrow), omohyoid muscle. (B) Superior loop (yellow arrow), suprascapular nerve; inferior loop (white arrow), distal motor branch of spinal accessory nerve. (C) Transfer distal motor branch of spinal accessory nerve to suprascapular nerve.

• 

  Fig. 2 This patient sustained whole arm type brachial plexus injury. His suprascapular nerve function remained, and the intercostal nerve could not be used as a donor due to damage of the chest wall. We did spinal accessory nerve (distal motor branch) transfer to musculocutaneous nerve (motor branch to brachialis and biceps muscle) with sural nerve graft. After that, contralateral C7 nerve (ventral division) transfer to median nerve using vascularized pedicled ulnar nerve graft was done. (A) Spinal accessory nerve was used to neurotize the musculocutaneous nerve (motor branch to brachialis and biceps muscle) with an interpositional sural nerve graft (yellow arrow). (B) Contralateral C7 nerve were dissected for transfer. Right loop (white arrow), C7 root; left loop (yellow arrow), anterior division. (C) Ipsilateral ulnar nerve was used as pedicled graft based on the superior ulnar collateral vessels to neurotize the median nerve. Its distal end is cut at the wrist level and mobilized in its full length to reach to contralateral C7 nerve (yellow arrows). The distal stump of the ulnar nerve is passed under the skin of the upper part of the chest to the contralateral C7 nerve. The anterior division of C7 nerve is matched and coapted to the distal end of the ulnar nerve (blue arrow). The proximal end of the ulnar nerve was sutured to median nerve (white arrow).

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  Fig. 3 This patient sustained brachial plexus injury with paralysis of musculocutaneous nerve and axillary nerve. We did ulnar nerve fascicular transfer to the brachialis motor branch and median nerve fascicular transfer to the biceps motor branch on supine position. After that, triceps motor branch was transfered to the axillary nerve. (A) Left loop (yellow arrow), brachialis motor branch of musculocutaneous nerve; right loop (white arrow), biceps motor branch of musculocutaneous nerve. (B) After ulnar nerve fascicular transfer to the brachialis motor branch (yellow arrow) and median nerve fascicular transfer to the biceps motor branch (white arrow). (C) Left side of inferior loop (blue arrow), triceps motor branch of the radial nerve; right side of inferior loop (red arrow), deltoid motor branch of the axillary nerve; left side of superior loop (yellow arrow), ulnar nerve; right side of superior loop (white arrow), sensory branch of axillary nerve. (D) After transfer of the triceps motor branch to the axillary nerve (yellow arrow).

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