Abstract
Background
Various studies published good outcomes in brachial plexus injuries using nerve transfers for shoulder and elbow functions. However, little is known about the outcome of the distal nerve transfers in the forearm and hand. Targeting the nerve distally produces an early return of function in brachial plexus and peripheral nerve injuries (BPPNI). Therefore, researchers have focused on nerve transfers from the motor branches of the ulnar, median, and radial nerve. Similarly, sensory reinnervation is also obtained by potential donor transfers in the forearm and hand. There have been various attempts by surgeons to target the muscle and promote early reinnervation by different nerve transfers.
Conclusions
The distal nerve transfers in the forearm and hand are promising when performed early. It effectively restores hand and forearm functions and may be considered a better option than tendon transfer, which has a one-tendon-one function. This narrative review article discusses the different distal nerve transfers for various presentations of BPNNI.
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Data are available subject to the patient's consent and confidentiality.
References
Bertelli, J. A. (2015). Transfer of the radial nerve branch to the extensor carpi radialis brevis to the anterior interosseous nerve to reconstruct thumb and finger flexion. The Journal of Hand Surgery America, 40(2), 323-328.e2. https://doi.org/10.1016/j.jhsa.2014.10.060. PMID: 25617956.
Bertelli, J. A., & Ghizoni, M. F. (2017). Nerve transfers for restoration of finger flexion in patients with tetraplegia. Journal of Neurosurgery: Spine SPI, 26(1), 55–61.
Domeshek, L. F., Novak, C., Patterson, J. M. M., Hasak, J. M., Yee, A., Kahn, L. C., & Mackinnon, S. E. (2019). Nerve transfers—a paradigm shift in the reconstructive ladder. Plastic and Reconstructive Surgery—Global Open, 7(6), e2290. https://doi.org/10.1097/GOX.0000000000002290
Grinsell, D., & Keating, C. P. (2014). Peripheral nerve reconstruction after injury: A review of clinical and experimental therapies. BioMed Research International, 2014, 698256.
Thakkar, M., Rose, A., King, W., Engelman, K., & Bednarz, B. (2022). Anterior interosseous nerve to ulnar nerve transfer: a systematic review. JPRAS Open, 11(32), 195–210. https://doi.org/10.1016/j.jpra.2022.02.007. PMID: 35498818; PMCID: PMC9043848.
Novak, C. B., & Mackinnon, S. E. (2002). Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. Journal of Reconstructive Microsurgery, 18(6), 459–464. https://doi.org/10.1055/s-2002-33326. PMID: 12177812.
Bertelli, J., Soldado, F., Ghizoni, M. F., & Rodríguez-Baeza, A. (2015). Transfer of a terminal motor branch nerve to the flexor carpi ulnaris for triceps reinnervation: Anatomical study and clinical cases. The Journal of Hand Surgery America, 40(11), 2229-2235.e2.
Socolovsky, M., Bonilla, G., Masi, G. D., & Bianchi, H. (2011). Transfer of flexor carpi ulnaris branches to selectively restore AIN function in median nerve sections: Anatomical feasibility study and case report. Surgical Neurology International, 2, 102. https://doi.org/10.4103/2152-7806.83231. Epub 2011 Jul 28. PMID: 21886875; PMCID: PMC3157088.
Bertelli, J. A., Soldado, F., Rodrígues-Baeza, A., & Ghizoni, M. F. (2019). Transferring the motor branch of the opponens pollicis to the terminal division of the deep branch of the ulnar nerve for pinch reconstruction. The Journal of Hand Surgery America, 44(1), 9–17. https://doi.org/10.1016/j.jhsa.2018.09.010. Epub 2018 Oct 23 PMID: 30366737.
Jerome, J. T. J. (2023). Adductor branch of terminal divisions of the ulnar nerve transfer to the thenar motor branch in a high median nerve palsy: A case report. JBJS Case Connect, 13(1), PMID: 36928133. https://doi.org/10.2106/JBJS.CC.22.00704
Boyd, K. U., Nimigan, A. S., & Mackinnon, S. E. (2011). Nerve reconstruction in the hand and upper extremity. Clinics in Plastic Surgery, 38(4), 643–660.
Bertelli, J. A. (2020). Nerve versus tendon transfer for radial nerve paralysis reconstruction. The Journal of Hand Surgery America, 45(5), 418–426.
Patterson, J. M. M., Russo, S. A., El-Haj, M., Novak, C. B., & Mackinnon, S. E. (2022). Radial nerve palsy: Nerve transfer versus tendon transfer to restore function. Hand (NY), 17(6), 1082–1089.
Moore, A. M., Wagner, I. J., & Fox, I. K. (2015). Principles of nerve repair in complex wounds of the upper extremity. Seminars in Plastic Surgery, 29(1), 40–47. https://doi.org/10.1055/s-0035-1544169.PMID:25685102;PMCID:PMC4317271
Battiston, B., & Lanzetta, M. (1999). Reconstruction of high ulnar nerve lesions by distal double median to ulnar nerve transfer. Journal of Hand Surgery, 24, 1185–1191.
Flores, L. P. (2013). Reanimation of elbow extension with medial pectoral nerve transfer in partial injuries to the brachial plexus. Journal of Neurosurgery, 118, 588–593.
Bertelli, J. A., & Ghizoni, M. F. (2011). Very distal sensory nerve transfers in high median nerve lesions. Journal of Hand Surgery, 36, 387–393.
Novak, C. B. (2008). Rehabilitation following motor nerve transfers. Hand Clinics, 24, 417–423.
Mackinnon, S. E., & Novak, C. B. (1999). Nerve transfers. New options for reconstruction following nerve injury. Hand Clinics, 15, 643–666.
Dellon, A. L., & Jabaley, M. E. (1982). Reeducation of sensation in the hand following nerve suture. Clinical Orthopaedics and Related Research, 163, 75–79.
Jerome, J. T., & Rajmohan, B. (2012). Axillary nerve neurotization with the anterior deltopectoral approach in brachial plexus injuries. Microsurgery, 32(6), 445–451. https://doi.org/10.1002/micr.21973. Epub 2012 Mar 21 PMID: 22434572.
Jerome, J. T. J. (2011). Long head of the triceps branch transfer to axillary nerve in C5, C6 brachial plexus injuries: Anterior approach. Plastic and Reconstructive Surgery, 128(3), 740–741. https://doi.org/10.1097/PRS.0b013e318221dd29. PMID: 21866001.
Terrence Jose Jerome, J. (2021). Influence of surgical approach in the outcome of double nerve transfer for shoulder function in the upper brachial plexus injuries. Orthoplastic Surgery, 6, 30–34. https://doi.org/10.1016/j.orthop.2021.11.002
Isaacs, J., & Cochran, A. R. (2019). Nerve transfers for peripheral nerve injury in the upper limb: a case-based review. Bone Joint Journal, 101-B(2), 124–131.
Giuffre, J. L., Bishop, A. T., Spinner, R. J., & Shin, A. Y. (2015). The best of tendon and nerve transfers in the upper extremity. Plastic and Reconstructive Surgery, 135(3), 617e–630e.
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TJJ: roles/writing/review—original draft, literature review, data curation, and conceptualization. CM: drawing, review, and editing.
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Jerome, J.T.J., Matsui, C. Distal Nerve Transfers in Hand and Forearm for Traumatic Brachial Plexus and Peripheral Nerve Injuries: A Narrative Review. JOIO 57, 1347–1358 (2023). https://doi.org/10.1007/s43465-023-00965-9
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DOI: https://doi.org/10.1007/s43465-023-00965-9