Abstract
Traumatic brachial plexus injuries are life changing, often leaving affected individuals
with severe functional deficits. Recent advances in nerve transfers have allowed surgeons
to improve elbow flexion, shoulder abduction, and prehension of the hand in some patients.
We hypothesize that in a patient who lacks both biceps and triceps function, a double
fascicular transfer may be the key to restore elbow flexion and extension. In three
cadaver upper limbs, we transferred the expendable motor fascicle of the ulnar nerve
to the biceps branch of the musculocutaneous nerve, and the expendable motor fascicle
of the median nerve to the triceps (ulnar collateral) branch of the radial nerve.
We evaluated the feasibility of this double nerve transfer via a medial approach,
and elucidated the anatomy. The transfers were easily performed and were tension-free
throughout full range of motion at the elbow. The triceps branch of the radial nerve
that we utilized has a length of approximately 4.9 cm, and is best found between 3.5
and 6 cm from the anterior axillary line. We consistently identified a relatively
avascular plane in the region between 7.5 and 11cm from the anterior axillary line,
which corresponds with the recipient sites of the medial head of the triceps. The
distance between the triceps branch to the median nerve was an average of 2.5 cm.
Transfer of expendable motor fascicles from the ulnar and median nerves to the biceps
and triceps nerve branches can be successfully and consistently performed through
a medial approach in a cadaver.
Keywords
nerve transfer - fascicular transfer - brachial plexus injury - elbow extension
