Postoperative motor deficits following elbow flexion reanimation by nerve transfer

Is one nerve transfer enough? A systematic review and pooled analysis comparing ulnar fascicular nerve transfer and double ulnar and median fascicular nerve transfer for restoration of elbow flexion after traumatic brachial plexus injury

“…Ray et al (2011) examined 15 patients with limited and extensive brachial plexus injuries who underwent double fascicular transfer, reporting that the first evidence of elbow flexor reinnervation occurred at a median of 5.4 months and that 97% of subjects had regained flexion (defined as a MRC score of 3 or above) at final follow-up (Ray et al, 2011). Finally, Le Hanneur et al (2018) reviewed 27 cases of ulnar and/or median nerve transfer for BPI. While it did not reach a conclusion about the optimal number of nerve transfers for regaining elbow flexion, this study documented postoperative complications and found that although 15% of double fascicular transfer patients developed a deficit, these issues were consistently transient and solved with a straightforward treatment option (Le Hanneur et al, 2018).…”

“…Finally, Le Hanneur et al (2018) reviewed 27 cases of ulnar and/or median nerve transfer for BPI. While it did not reach a conclusion about the optimal number of nerve transfers for regaining elbow flexion, this study documented postoperative complications and found that although 15% of double fascicular transfer patients developed a deficit, these issues were consistently transient and solved with a straightforward treatment option (Le Hanneur et al, 2018).…”

“…Several studies demonstrate the success of ulnar fascicular transfer (Coulet, Boretto, Lazerges, & Chammas, ; Leechavengvongs, Witoonchart, Uerpairojkit, Thuvasethakul, & Ketmalasiri, ; Liu et al, ; Moses, Dai, Lowe, Chu, & Protopsaltis, ; Verdins & Kapickis, ), but in 2006, double fascicular transfer (DFT) was proposed by Mackinnon, Novak, Myckatyn, and Tung (). In double fascicular transfer, in addition to ulnar nerve fascicular transfer to the MCN, motor fascicles from the median nerve are also transferred to the MCN to innervate the brachialis muscle (Le Hanneur et al, ). Multiple studies have been performed in small cohorts and have found satisfactory outcomes using both techniques (Barthel et al, ; Le Hanneur et al, ; Wang, Rancy, Lee, Feinberg, & Wolfe, ).…”

“…In double fascicular transfer, in addition to ulnar nerve fascicular transfer to the MCN, motor fascicles from the median nerve are also transferred to the MCN to innervate the brachialis muscle (Le Hanneur et al, ). Multiple studies have been performed in small cohorts and have found satisfactory outcomes using both techniques (Barthel et al, ; Le Hanneur et al, ; Wang, Rancy, Lee, Feinberg, & Wolfe, ). The potential gains in elbow flexion strength with additional nerve transfer in these patients must be weighed with the morbidity of harvesting more functional nerve tissue.…”

“…Multiple studies have been performed in small cohorts and have found satisfactory outcomes using both techniques (Barthel et al, 2014;Le Hanneur et al, 2018;Wang, Rancy, Lee, Feinberg, & Wolfe, 2016). The potential gains in elbow flexion strength with additional nerve transfer in these patients must be weighed with the morbidity of harvesting more functional nerve tissue.…”