Nerve transfers for brachial plexus injuries

Traumatic adult brachial plexus injuries are a devastating injury that result in partial or total denervation of the muscles of the upper extremity. Treatment of these injuries has been evolving over the past several decades. Treatment options include neurolysis, nerve grafting, neurotization (nerve transfer), or use of free functioning gracilis muscle transfers. Neurotization is the transfer of a functional but less important nerve to a denervated more important nerve. It has become an important procedure in the restoration of function in patients with brachial plexus injuries and allows the reinnervation of muscles that are affected by otherwise irreparable preganglionic lesions. The introduction of novel nerve transfers has improved shoulder abduction and elbow flexion, and in select cases, even provided a reasonable possibility for grasp function. This paper will review commonly used neurotizations in brachial plexus reconstruction, the rationale for their use, as well as techniques, results and controversies.