Nerve Transfers (peripheral nerve disorders)

A nerve transfer is when a normal nerve is cut and subsequently attached to the distal end of an injured nerve, preferably as close as possible to the muscle. This is often performed when the proximal portion of the injured nerve is not available for direct or graft repair (e.g., when the injured nerve is pulled from the spinal cord during a brachial plexus injury). In select cases, a nerve transfer is recommended even when a graft repair is possible.

A normal donor nerve is selected so that the patient does not notice it being cut (e.g., from a muscle that has multiple branches, or from a muscle that shares function with other muscles). In general, the nerve receiving the transfer is more important than the donor. Even though the nerves are re-routed, brain plasticity allows for contraction to occur without difficulty in most patients.

Nerve Transfers
Examples of nerve transfers.
Intercostal to musculocutaneous
nerve transfer using three
intercostal donors (above).
Triceps branch to the anterior
division of the axillary nerve
transfer (middle). Medial pectoral
nerve transfer to the axillary
nerve (below).

Examples are listed below:

  • Hypoglossal to facial
  • Hypoglossal to spinal accessory
  • Spinal accessory to suprascapular - anterior approach
  • Spinal accessory to suprascapular - posterior approach
  • Spinal accessory to musculocutaneous
  • Medial pectoral to axillary
  • Medial pectoral to musculocutaneous
  • Thoracodorsal to axillary
  • Thoracodorsal to musculocutaneous
  • Triceps branch to axillary
  • Intercostals to musculocutaneous
  • Intercostals to long thoracic
  • Ulnar fascicle to biceps branch
  • Median fascicle to brachialis branch
  • Anterior interosseous to ulnar motor branch
  • Femoral branch to gluteal nerve
  • Femoral branch to hamstring branch
  • Femoral branch to obturator
  • Tibial branch to tibialis anterior

     

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