Nerve transfer in irreversible injuries of upper limb nerve: Current knowledge and future perspective
Objective: To share the experience of using nerve transfer in the irreparable upper limb nerve damage. Methods: An analysis was made of various transfers (neurotization surgery) in 32 patients with upper limb nerve damage aged 22 to 59 years (27 males, 5 females). Nerve injuries were localised at the level of the forearm (18), shoulder (11) and brachial plexus (3). Surgical repair was aimed at restoring sensitivity and movement in 22 and 10 cases, respectively. For sensitive neurotization, the cutaneous branches of the radial nerve (RN), the dorsal branch of the ulnar nerve (UN), the superficial branch of the UN, and the cutaneous nerves of the forearm were more often used. Motor neurotization was achieved using the branches of the anterior interosseous nerve (AIN), thoracodorsal nerve (TDN), muscular branches of the UN, intercostal nerves (ICNs), and terminal and muscular branches of the brachial and cervical plexuses, respectively. Results: Long-term outcomes were evaluated between years 1 and 8. Sensitivity was restored to S3 grade (protective sensitivity), and motor strength reached M3-M4 grades according to British Medical Research Council (MRC) scale. Conclusion: Nerve transfer in irreparable nerve damage allows expanding the boundaries of reconstructive surgery. Furthermore, it opens new horizons for future scientific research to improve modern surgical treatment concepts of peripheral nerve injuries.