title: Multiple nerve and tendon transfers: a new strategy for restoring hand function in a patient with C7-T1 brachial plexus avulsions.
abstract: C7-T1 brachial plexus palsies result in a loss of finger motion and hand function. The authors have observed that finger flexion motion can be recovered after a brachialis motor branch transfer. However, finger flexion strength after this procedure merely corresponds to Medical Research Council Grades M2-M3, lowering the grip strength and practical value of the reconstructed hand. Therefore, they used 2 donor nerves and accomplished double nerve transfers for stronger finger flexion. In a patient with a C7-T1 brachial plexus injury, they transferred the pronator teres branch to the anterior interosseous nerve and the brachialis motor branch to the flexor digitorum superficialis branch for reinnervation of full finger flexors. Additionally, the supinator motor branch was transferred for finger extension, and the brachioradialis muscle was used for thumb opposition recovery. Through this new strategy, the patient could successfully accomplish grasping and pinching motions. Moreover, compared with previous cases, the patient in the present case achieved stronger finger flexion and grip strength, suggesting practical improvements to the reconstructed hand.
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University.|Key Laboratory of Hand Reconstruction, Ministry of Health; and.|Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University.|Key Laboratory of Hand Reconstruction, Ministry of Health; and.|Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Dong
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University.|Key Laboratory of Hand Reconstruction, Ministry of Health; and.|Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China.
authors.forename: Cheng-Gang
authors.initials: CG
authors.lastname: Zhang
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University.|Key Laboratory of Hand Reconstruction, Ministry of Health; and.|Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China.
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Gu
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery*; D006225:Hand / Q000294:innervation* / Q000502:physiology*; D006801:Humans; D008297:Male; D016067:Nerve Transfer / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000534:rehabilitation* / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013709:Tendon Transfer / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000534:rehabilitation* / Q000601:surgery*
keywords: AIN = anterior interosseous nerve; FDP = flexor digitorum profundus; FDS = flexor digitorum superficialis; FPL = flexor pollicis longus; MRC = Medical Research Council; PIN = posterior interosseous nerve; PT = pronator teres; brachial plexus injury; hand reconstruction; nerve transfer; peripheral nerve; tendon transfer