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Double Fascicular Nerve Transfer


Title: Double Fascicular Nerve Transfer - Median/Ulnar Fascicles to Biceps/Brachialis Branches.
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 double fascicular transfer is the choice nerve transfer of our institution for musculocutaneous nerve palsies. In cases that involve an unusual direct injury to the musculocutaneous nerve and a site of injury close to target, a direct nerve repair or nerve graft is the more appropriate surgical intervention. The double fascicular transfer utilizes nerve fascicules to the flexor digitorum superficialis/flexor carpi radialis of the median nerve and the flexor carpi ulnaris of the ulnar nerve to reinnervate the biceps brachii and brachialis muscles. This procedure was established by the senior author as a modification of the single fascicular Oberlin transfer to include the brachialis muscle as a target for reinnervation in addition to the biceps brachii muscle. At our institution, the double fascicular transfer has proven to be an excellent procedure for recovering musculocutaneous nerve function by utilizing two donor nerve fascicles, flexor digitorum superficialis/flexor carpi radialis and flexor carpi ulnaris, to reinnervate two targets, biceps brachii and brachialis.

Figures and Videos

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Extended Version 

Surgical Tutorial – Double Fascicular Nerve Transfer. The double fascicular transfer (DFT) includes two nerve transfers: (1) median fascicle to biceps branch and (2) ulnar fascicle to brachialis branch. The median fascicle contains nerve fibers that innervate flexor digitorum superficialis / flexor carpi radialis. The ulnar fascicle contains nerve fibers that innervate flexor carpi ulnaris. The donor fascicles can be used for either recipient nerves depending on the length required, but the nerve transfers described above are typically used. The DFT is used to restore elbow flexion when median and ulnar nerves are intact.