Nerve transfers in the upper extremity

Complex upper-extremity nerve injuries are a challenging problem for the reconstructive hand surgeon. Traditionally, nerve grafts or tendon transfers have provided options for restoration of function. Advances in nerve repair and in the understanding of the internal topography of the nerve have contributed to the development of the use of nerve transfers. Nerve-to-nerve transfers offer a superior alternative for functional restoration in isolated or multiple nerve injuries when early reinnervation of the target end organ is necessary, such as in proximal injuries or in delayed treatment. Expendable sensory or motor axons close to the end organ allow for earlier regeneration and preclude the need for nerve grafts. Assessment and criteria for nerve transfers as well as the management, surgical techniques, and outcomes for well-established nerve transfers are described.