title: Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity.
abstract: BACKGROUND
  Peripheral nerve transfers are being used to improve upper extremity function in cervical spinal cord injury (SCI) patients. The purpose of this study was to evaluate feasibility and perioperative complications following these procedures.
  
  
  METHODS
  Eligible SCI patients with upper extremity dysfunction were assessed and followed for a minimum of 3 months after surgery. Data regarding demographics, medical history, physical examination, electrodiagnostic testing, intraoperative nerve stimulation, recipient nerve histomorphometry, surgical procedure, and complications were collected.
  
  
  RESULTS
  Seven patients had surgery on eight limbs, mean age of 28 ± 9.9 years and mean time from SCI injury of 5.1 ± 5.2 years. All patients had volitional elbow flexion and no volitional hand function. The nerve to the brachialis muscle was used as the expendable donor, and the recipients included the anterior interosseous nerve (AIN) (for volitional prehension), nerve branches to the flexor carpi radialis, and flexor digitorum superficialis. Two patients underwent additional nerve transfers: (1) supinator to extensor carpi ulnaris or (2) deltoid to triceps. No patients had any loss of baseline upper extremity function, seven of eight AIN nerve specimens had preserved micro-architecture, and all intraoperative stimulation of recipient neuromuscular units was successful further supporting feasibility. Four patients had perioperative complications; all resolved or improved (paresthesias).
  
  
  CONCLUSIONS
  Nerve transfers can be used to reestablish volitional control of hand function in SCI. This surgery does not downgrade existing function, uses expendable donor nerve, and has no postoperative immobilization, which might make it a more viable option than traditional tendon transfer and other procedures.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Box 8238, 660 South Euclid Avenue, Saint Louis, MO 63110 USA.
authors.forename: Ida K
authors.initials: IK
authors.lastname: Fox
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Davidge
authors.affiliation: Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, EW2-422, Toronto, ON M5T 2S8 Canada.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Novak
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Box 8238, 660 South Euclid Avenue, Saint Louis, MO 63110 USA.
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Hoben
authors.affiliation: Milliken Hand Center, The Rehabilitation Institute of Saint Louis, Suite 6F, 4921 Parkview Place, Saint Louis, MO 63110 USA.
authors.forename: Lorna C
authors.initials: LC
authors.lastname: Kahn
authors.affiliation: Division of Neurorehabilitation, Spinal Cord Injury Program, Department of Neurology, Washington University School of Medicine, Box 8518, 660 South Euclid Avenue, Saint Louis, MO 63110 USA.
authors.forename: Neringa
authors.initials: N
authors.lastname: Juknis
authors.affiliation: Division of Neurorehabilitation, Spinal Cord Injury Program, Department of Neurology, Washington University School of Medicine, Box 8518, 660 South Euclid Avenue, Saint Louis, MO 63110 USA.
authors.forename: Rimma
authors.initials: R
authors.lastname: Ruvinskaya
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Box 8238, 660 South Euclid Avenue, Saint Louis, MO 63110 USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Mackinnon
keywords: Nerve transfer; Peripheral nerve; Spinal cord injury; Surgery; Tetraplegia