Nerve Transfers that Work: A Retrospective Review of a Single Centre's Experience
Rowan M Chandler, MD and Jennifer L Giuffre, MD, University of Manitoba, Winnipeg, MB, Canada
Introduction: In patients with proximal motor nerve injuries, nerve transfers allow re-innervation of the target muscle by co-apting nerves closer to the motor endplates and, in the case of supercharging, increase the number of total motor axons reaching the target muscle.
Methods: A retrospective review was conducted of all nerve transfers performed by two surgeons at a single centre between 2011 and 2018. These included triceps branch to axillary nerve, spinal accessory to suprascapular nerve, brachialis branch to anterior interosseous nerve, ulnar nerve fascicle (FCU) to biceps nerve/double fascicular nerve transfer, AIN to ulnar motor nerve, and flexor hallucis longus to anterior tibialis nerve transfer.Primary outcome measures were motor function using the British Medical Research Council grading system.
Results: 129 patients met the inclusion criteria. 29 patients underwent triceps nerve to axillary nerve transfer resulting in an average BMRC of 3.2. The spinal accessory to suprascapular nerve group included 12 patients with an average BMRC of 2.6. Of the 3 patients who underwent a brachialis to AIN nerve transfer, BMRC was assessed separately for the flexor pollicus longus (FPL) and flexor digitorum profundus (FDP) of the index. Outcomes were inconsistent and unreliable (average BMRC of FPL= 1, of FDP index = 2.3). The ulnar nerve fascicle (FCU) to biceps/double fascicle nerve transfer group (n = 9) did well with an average BMRC of 3.8.
Our largest group was the AIN to ulnar motor nerve transfer (n=40). Of all patients who underwent the transfer, regardless of time to surgery or mechanism of ulnar neuropathy, the average BMRC was 2.7. Within this group there was a trend for better recovery in patients who received surgery earlier (<7months = BMRC of 3.3 and >12months = BMRC of 2.6), as well as patient who received end to side neurorraphy (end-to-side >12 months = 3.0, <12 months = 3.7; end-to-end >12 months = 2.0, <12 months = 1.7). The FHL nerve to anterior tibialis nerve transfer group had an average BMRC of 2.5. Complications included one patient with temporary neuropraxia and one patient with CRPS.
Conclusions: The results of our nerve transfers are similar to those published in the literature, with the exception of the spinal accessory to suprascapular nerve and the brachialis to AIN nerve transfers. Nerve transfers that are performed early and in an end to side fashion did better than later nerve transfers and end to end neurorrhaphies.
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