Nerve transfer (or neurotisation) involves the transfer of a functioning fascicle or nerve branch (expendable donor) to a denervated muscle.
Principles of motor nerve transfer (MacKinnon):
• Donor nerve near target motor end plates
• Expendable donor nerve
• Pure motor donor nerve
• Donor-recipient size match
• Donor function synergy with recipient function
• Motor re-education improves function
The choice of a donor nerve follows the same principles of tendon transfer:
- What (nerve) is not working?
- What function needs restoring?
- What (donor) nerves are available (in the vicinity)?
- What is the most appropriate donor nerve?
Some commonly performed nerve transfers:
• Restoration of elbow flexion
o Ulnar nerve fascicle (FCU) to musculocutaneous nerve branch (biceps)
o Median nerve fascicle (FCR) to musculocutaneous nerve branch (brachialis)
• Restoration of shoulder function and stability
o Spinal accessory nerve to suprascapular nerve
o Radial nerve branch (triceps) to axillary nerve (deltoid)