Title: Extensor Carpi Radialis Brevis to Anterior Interosseous Nerve Transfer.
Published: 4/11/2011, Updated: 4/11/2011.
Author(s): Susan E. Mackinnon MD, Andrew Yee BS.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
The senior author’s preferred nerve transfer to reinnervate anterior interosseous nerve (AIN) function is the brachialis to anterior interosseous nerve transfer. However, in cases with major brachial plexus injuries, the brachialis nerve will not be available as a donor nerve due to its C5,6 root origination. In these cases, the nerve to the extensor carpi radialis brevis (ECRB) is an excellent donor nerve substitute when available. The ECRB to AIN nerve transfer is an easier and quicker transfer when compared to the brachialis to AIN nerve transfer due to a few different technical points. These technical points include that the ECRB to AIN nerve transfer does not require interfascicular dissection and the nerve transfer is closer to the AIN motor targets than the brachialis transfer. The surgical exposure for the ECRB to the AIN nerve transfer occurs in the proximal-forearm, at the level of the median nerve, where the AIN branches and is easily identified lateral to the median nerve. In comparison, the brachialis to AIN nerve transfer occurs in the mid-arm and requires intrafascicular dissection of the median in order to mobilize the recipient AIN fascicle for transfer. In summary, for severe brachial plexus injuries, the ECRB nerve is an excellent donor nerve choice to reinnervate AIN function when the brachialis nerve is not available.