Reconstruction for Nerve Palsy -Tendon Transfers and Nerve transfers-Nerve Transfers for the Upper Extremity: New Horizons in Nerve Reconstruction

Nerve Transfers for the Upper Extremity: New Horizons in Nerve Reconstruction

Pdf Summary

Nerve transfers are a surgical technique used in brachial plexus and complex nerve reconstruction. The advantages of nerve transfers are that they shorten the distance for nerve regeneration, allow for specific selection of motor or sensory nerve fascicles as donors, and generally do not require nerve grafts. Nerve transfers can be intraplexal, extraplexal, or distal, and each type serves a unique role in the reconstructive process. Diagnostic workup and intraoperative assessment help guide the surgeon in determining the appropriate use of nerve transfers. Nerve transfers have had a positive impact on the outcomes of nerve surgery and are considered essential tools in complex nerve reconstruction. Some pioneers in nerve transfer surgery include Flouren, Balance, Vulpius, and Seddon. The surgical coaptation of a healthy nerve donor to a denervated nerve is the definition of nerve transfer. The principle is similar to that of tendon transfers, where expendable donor nerves are used to restore function in denervated nerves. Nerve transfers have been especially useful in brachial plexus injury reconstruction, as well as in other complex peripheral nerve injuries. However, there are some contraindications for nerve transfer, including the presence of a better reconstructive option, excessive time between injury and reinnervation, or weak donor nerve motor strength. Nerve transfer has several advantages over primary nerve repair and nerve grafting, including shorter distances for nerve regeneration, selection of pure motor or sensory fascicles, and achieving synchronous physiologic motion. There are several types of nerve transfer, including intraplexal, extraplexal, distal, single, dual, direct, motor, sensory, end-to-end, end-to-side, and reverse end-to-side transfers. Each transfer has a unique role in restoring specific motor or sensory functions in the upper extremity.

Keywords

nerve transfers

surgical technique

brachial plexus

complex nerve reconstruction

nerve regeneration

motor nerve fascicles

sensory nerve fascicles

intraplexal transfers

extraplexal transfers

distal transfers