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Nerve Transfers


Nerve transfers in the hand are devised to restore hand function and critical sensation through reinnervation of the target muscles or sensory territories. The motor function of the hand can be organized into three categories: median, radial, and ulnar nerve function. The principle nerves that are targeted for reinnervation are the anterior interosseous nerve (median), posterior interosseous nerve (radial), and deep motor branch (ulnar). Motor nerve transfers are time sensitive due to muscle atrophy and loss of motor end-plates.
Restoration of hand sensation can be accomplished through nerve transfers by donating non-critical sensory territories to reinnervate critical sensory territories that include 1st webspace, ulnar cutaneous aspect of the hand, and the posterior radial aspect of the hand. These critical territories are restored through an end-to-end (ETE) nerve transfer. While there is lost of donor nerve, it can be preserved to a rudimentary level through an end-to-side (ETS) nerve transfer. Non-critical sensation can also be restored to a rudimentary level through the same ETS method. The combination of ETE and ETS nerve transfers allows for the best clinical outcome for sensory reinnervation. Unlike motor nerve transfers, sensory nerve transfers are not time sensitive.