American Society for Peripheral Nerve

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Double Distal Nerve Transfer for Hand Reconstruction after Lower Brachial Plexus Injuries
Zhongyu Li, MD, PhD
Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC

Hypothesis: Lower brachial plexus injury (LBPI) remains a clinical challenge. Early distal nerve transfer may provide useful thumb and finger functional recovery.

Material & Methods: Four patients were treated with distal double nerve transfer for LBPI. There were 3 males and one female, 3 of them involved in the right side. The mean age at surgery was 22 (17-26) years old. The procedure includes transferring a pronator branch of the median nerve (PBMN) to the anterior interosseous nerve (AIN) and a supinator branch of the radial nerve (SBRN) to the posterior interosseous nerve (PIN). The mean time of delay from injury to surgery was 7.5 (5-13) months. The mean follow-up was 19 (6-36) months.

Results: The first 2 patients achieved M4 of EPL/EDC and M4 of FPL /FDP. The other two more recent patients showed signs of motor recovery 6-9 months after surgery. There was no functional loss of forearm pronation or supination after surgery.


  • Simultaneous double distal transfer of a PBMN to AIN and a SBRN to PIN is a reliable technique for patients with LBPI.
  • The advantages of this procedure include:
    1) transfers can be performed through one incision with minimal intraneural dissection;
    2) the transferred nerves are very close to the targeting muscles;
    3) there is no need for nerve graft;
    4) both transfers are in-phase with ease in post-op therapy.
  1. Gu Y, et al... Transfer of brachialis branch of musculocutaneous nerve for finger flexion: anatomic study and case report. Microsurgery. 2004;24:358-62
  2. Dong Z, et al. Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7-T1 brachial plexus palsies. J Neurosurg. 2010: 13:113-7
  3. Bertelli JA et at. Transfer of the pronator quadratus motor branch for wrist extension reconstruction in brachial plexus palsy. Plast Reconstr Surg. 2012;130:1269-78

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