Nerve transfers

Nerve injuries can be devastating to the patients they affect, as well as provide the surgeon with challenging reconstructive problems. There are a number of ways to manage these nerve injuries. Typically nerve transfers have been used with the most severe nerve injuries when no other options are available. Due to the slow rate of nerve regeneration and the finite length of time available to reinnervate the motor end plates, the recovery from proximal nerve injuries has historically been poor. The indications for nerve transfers have evolved to situations where anatomical repair or graft at the level of a proximal injury would historically yield poor functional recovery. The transfer of distal donor motor and sensory axons closer to their targets to maximize recovery precludes the need for donor nerve grafts and most importantly reduces the regeneration time. A number of motor and sensory nerve transfer options for the upper extremity are discussed.