title: Transfer of a Terminal Motor Branch Nerve to the Flexor Carpi Ulnaris for Triceps Reinnervation: Anatomical Study and Clinical Cases.
abstract: OBJECTIVE
  To analyze the anatomical feasibility of transferring a motor branch nerve to the flexor carpi ulnaris (FCU) to the triceps upper medial head motor branch (UMHM) and to report the resultant outcome of the restoration of elbow extension in 5 patients with extensive brachial plexus injury.
  
  
  METHODS
  The ulnar and radial nerves were dissected in 10 cadavers. We measured the length and diameter of the branches to the FCU and the UMHM branch and counted the axons. Then, 5 male patients, mean age 30 years, underwent FCU nerve branch transfer for reconstruction of elbow extension. Elbow flexion was restored via a median nerve branch to biceps transfer.
  
  
  RESULTS
  Mean UMHM nerve length and diameter were 86 and 1.5 mm, respectively. Mean number of branches to the FCU muscle was 2.9. Mean FCU nerve length and diameter were 50 and 1.0 mm, respectively. Mean number of myelinated fibers was 818 and 743 for the UMHM and the longest branch to the FCU, respectively. Coaptation between nerves was possible without tension. All patients recovered functional active elbow extension at a mean follow-up of 19 months with a British Medical Research Council score of M4. After surgery, all patients retained a functional FCU with a British Medical Research Council score of M4.
  
  
  CONCLUSIONS
  Nonselective ulnar nerve fascicles at the root of the limb might not be adequate to restore elbow extension when combined with a median nerve branch transfer for elbow flexion. A selective distal ulnar motor fascicle such as a FCU motor branch could be harvested and connected to a triceps branch to restore elbow extension. Such a nerve transfer would also allow for later transfer of the still functional FCU tendon to the digital extensors.
  
  
  CONCLUSIONS
  For patients with extensive brachial plexus injury and a preserved medial cord, transferring a motor branch nerve to the FCU is an effective technique for the reconstruction of elbow extension.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil; Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil.
authors.forename: Jayme
authors.initials: J
authors.lastname: Bertelli
authors.affiliation: Pediatric Hand Surgery and Microsurgery Unit, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain. Electronic address: drsoldado@cirugiamanoinfantil.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Soldado
authors.affiliation: Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil.
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Ghizoni
authors.affiliation: Human Anatomy Unit, Morphologic Sciences Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Rodríguez-Baeza
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D001132:Arm / Q000294:innervation; D001134:Arm Injuries / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D002102:Cadaver; D004550:Elbow / Q000502:physiology; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation*; D016067:Nerve Transfer / Q000379:methods*; D011826:Radial Nerve / Q000033:anatomy & histology / Q000637:transplantation*; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000033:anatomy & histology / Q000637:transplantation*
keywords: Brachial plexus palsy; elbow extension palsy; flexor carpi ulnaris; nerve transfer; ulnar nerve