, Volume 16, Issue 1, pp 26–35 | Cite as

Novel Uses of Nerve Transfers

  • Thomas J. WilsonEmail author


Nerve transfer surgery involves using a working, functional nerve with an expendable or duplicated function as a donor to supply axons and restore function to an injured recipient nerve. Nerve transfers were originally popularized for the restoration of motor function in patients with peripheral nerve injuries. However, more recently, novel uses of nerve transfers have been described, including nerve transfers for sensory reinnervation, nerve transfers for spinal cord injury and stroke patients, supercharge end-to-side nerve transfers, and targeted muscle reinnervation for the prevention and treatment of postamputation neuroma pain. The uses for nerve transfers and the patient populations that can benefit from nerve transfer surgery continue to expand. Awareness about these novel uses of nerve transfers among the medical community is important in order to facilitate evaluation and treatment of these patients by peripheral nerve specialists. A lack of knowledge of these techniques continues to be a major barrier to more widespread implementation.

Key Words

Nerve injury nerve transfer sensory reinnervation spinal cord injury supercharge end-to-side transfer targeted muscle reinnervation 


Compliance with Ethical Standards

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.


The author has no financial disclosures to report related to this article.

Conflict of Interest

The author declares that he has no conflicts of interest.

Supplementary material

13311_2018_664_MOESM1_ESM.pdf (1.2 mb)
ESM 1 (PDF 1224 kb)


  1. 1.
    Ray WZ, Chang J, Hawasli A, Wilson TJ, Yang L. Motor Nerve Transfers: A Comprehensive Review. Neurosurgery 2016;78(1):1–26.CrossRefGoogle Scholar
  2. 2.
    Mackinnon SE. Donor Distal, Recipient Proximal and Other Personal Perspectives on Nerve Transfers. Hand Clinics 2016;32(2):141–151.CrossRefGoogle Scholar
  3. 3.
    Smith BW, Daunter AK, Yang LJ, Wilson TJ. An Update on the Management of Neonatal Brachial Plexus Palsy-Replacing Old Paradigms: A Review. JAMA Pediatrics 2018;172(6):585–591.CrossRefGoogle Scholar
  4. 4.
    Fu SY, Gordon T. Contributing factors to poor functional recovery after delayed nerve repair: prolonged axotomy. The Journal of Neuroscience 1995;15(5 Pt 2):3876–3885.CrossRefGoogle Scholar
  5. 5.
    Borisov AB, Carlson BM. Cell death in denervated skeletal muscle is distinct from classical apoptosis. The Anatomical Record 2000;258(3):305–318.CrossRefGoogle Scholar
  6. 6.
    Oberlin C, Ameur NE, Teboul F, Beaulieu JY, Vacher C. Restoration of elbow flexion in brachial plexus injury by transfer of ulnar nerve fascicles to the nerve to the biceps muscle. Techniques in Hand & Upper Extremity Surgery 2002;6(2):86–90.CrossRefGoogle Scholar
  7. 7.
    Oberlin C, Beal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. The Journal of Hand Surgery 1994;19(2):232–237.CrossRefGoogle Scholar
  8. 8.
    Teboul F, Kakkar R, Ameur N, Beaulieu JY, Oberlin C. Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy. The Journal of Bone and Joint Surgery American volume 2004;86-a(7):1485–1490.CrossRefGoogle Scholar
  9. 9.
    Xu B, Dong Z, Zhang CG, Gu YD. Transfer of the radial branch of the superficial radial nerve to the sensory branch of the ulnar nerve for sensory restoration after C7-T1 brachial plexus injury. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 2016;69(3):318–322.CrossRefGoogle Scholar
  10. 10.
    Bertelli JA. Distal sensory nerve transfers in lower-type injuries of the brachial plexus. The Journal of Hand Surgery 2012;37(6):1194–1199.CrossRefGoogle Scholar
  11. 11.
    Foroni L, Siqueira MG, Martins RS, Oliveira GP. The intercostobrachial nerve as a sensory donor for hand reinnervation in brachial plexus reconstruction is a feasible technique and may be useful for restoring sensation. Arquivos de Neuro-Psiquiatria 2017;75(7):439–445.CrossRefGoogle Scholar
  12. 12.
    Foroni L, Siqueira MG, Martins RS, Heise CO, Sterman HN, Imamura AY. Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor. Arquivos de Neuro-Psiquiatria 2017;75(11):796–800.CrossRefGoogle Scholar
  13. 13.
    Oberlin C, Teboul F, Severin S, Beaulieu JY. Transfer of the lateral cutaneous nerve of the forearm to the dorsal branch of the ulnar nerve, for providing sensation on the ulnar aspect of the hand. Plastic and Reconstructive Surgery 2003;112(5):1498–1500.CrossRefGoogle Scholar
  14. 14.
    Doi K, Hattori Y, Kuwata N, Soo-heong T, Kawakami F, Otsuka K, et al. Free muscle transfer can restore hand function after injuries of the lower brachial plexus. The Journal ofBone and Joint Surgery British volume 1998;80(1):117–120.CrossRefGoogle Scholar
  15. 15.
    Brunelli GA. Sensory nerves transfers. Journal of Hand Surgery 2004;29(6):557–562.CrossRefGoogle Scholar
  16. 16.
    Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clinical Orthopaedics and Related Research 1987(218):136-41.Google Scholar
  17. 17.
    King JC. Peroneal neuropathy. In: Frontera WR, Silver JK, Rizzo TD, editors. Essentials of physical medicine and rehabilitation. Philadelphia, PA: Saunders; 2008. p. 389–393.Google Scholar
  18. 18.
    Moore AM, Krauss EM, Parikh RP, Franco MJ, Tung TH. Femoral nerve transfers for restoring tibial nerve function: an anatomical study and clinical correlation: a report of 2 cases. Journal of Neurosurgery 2017:1–2010.Google Scholar
  19. 19.
    Tung TH, Martin DZ, Novak CB, Lauryssen C, Mackinnon SE. Nerve reconstruction in lumbosacral plexopathy. Case report and review of the literature. Journal of Neurosurgery 2005;102(1 Suppl):86–91.Google Scholar
  20. 20.
    Rodriguez-Lorenzo A, Gago B, Pineda AF, Bhatti M, Audolfsson T. Superficial peroneal and sural nerve transfer to tibial nerve for restoration of plantar sensation after complex injuries of the tibial nerve: cadaver feasibility study. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 2011;64(11):1512–1516.CrossRefGoogle Scholar
  21. 21.
    Koshima I, Nanba Y, Tsutsui T, Takahashi Y. Deep peroneal nerve transfer for established plantar sensory loss. Journal of Reconstructive Microsurgery 2003;19(7):451–454.CrossRefGoogle Scholar
  22. 22.
    Rosenberg ML. Congenital trigeminal anaesthesia. A review and classification. Brain: a journal of neurology 1984;107 ( Pt 4):1073–1082.CrossRefGoogle Scholar
  23. 23.
    Garcia-Hirschfeld J, Lopez-Briones LG, Belmonte C. Neurotrophic influences on corneal epithelial cells. Experimental Eye Research 1994;59(5):597–605.CrossRefGoogle Scholar
  24. 24.
    Fung SSM, Catapano J, Elbaz U, Zuker RM, Borschel GH, Ali A. In Vivo Confocal Microscopy Reveals Corneal Reinnervation After Treatment of Neurotrophic Keratopathy With Corneal Neurotization. Cornea 2018;37(1):109–112.CrossRefGoogle Scholar
  25. 25.
    Elbaz U, Bains R, Zuker RM, Borschel GH, Ali A. Restoration of corneal sensation with regional nerve transfers and nerve grafts: a new approach to a difficult problem. JAMA Ophthalmology 2014;132(11):1289–1295.CrossRefGoogle Scholar
  26. 26.
    Bains RD, Elbaz U, Zuker RM, Ali A, Borschel GH. Corneal neurotization from the supratrochlear nerve with sural nerve grafts: a minimally invasive approach. Plastic and Reconstructive Surgery 2015;135(2):397e-400e.CrossRefGoogle Scholar
  27. 27.
    Krieger LM, Krieger AJ. The intercostal to phrenic nerve transfer: an effective means of reanimating the diaphragm in patients with high cervical spine injury. Plastic and Reconstructive Surgery 2000;105(4):1255–1261.Google Scholar
  28. 28.
    Nandra KS, Harari M, Price TP, Greaney PJ, Weinstein MS. Successful Reinnervation of the Diaphragm After Intercostal to Phrenic Nerve Neurotization in Patients With High Spinal Cord Injury. Annals of Plastic Surgery 2017;79(2):180–182.CrossRefGoogle Scholar
  29. 29.
    Fox IK. Nerve Transfers in Tetraplegia. Hand Clinics 2016;32(2):227–242.CrossRefGoogle Scholar
  30. 30.
    Bertelli JA, Ghizoni MF. Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries. Journal of Neurosurgery 2015;122(1):121–127.CrossRefGoogle Scholar
  31. 31.
    Bertelli JA, Ghizoni MF, Tacca CP. Transfer of the teres minor motor branch for triceps reinnervation in tetraplegia. Journal of Neurosurgery 2011;114(5):1457–1460.CrossRefGoogle Scholar
  32. 32.
    Bertelli JA, Tacca CP, Winkelmann Duarte EC, Ghizoni MF, Duarte H. Transfer of axillary nerve branches to reconstruct elbow extension in tetraplegics: a laboratory investigation of surgical feasibility. Microsurgery 2011;31(5):376–381.CrossRefGoogle Scholar
  33. 33.
    Bertelli JA, Ghizoni MF. Transfer of nerve branch to the brachialis to reconstruct elbow extension in incomplete tetraplegia: case report. The Journal of Hand Surgery 2012;37(10):1990–1993.CrossRefGoogle Scholar
  34. 34.
    van Zyl N, Hahn JB, Cooper CA, Weymouth MD, Flood SJ, Galea MP. Upper limb reinnervation in C6 tetraplegia using a triple nerve transfer: case report. The Journal of Hand Surgery 2014;39(9):1779–1783.CrossRefGoogle Scholar
  35. 35.
    Friden J, Gohritz A. Brachialis-to-extensor carpi radialis longus selective nerve transfer to restore wrist extension in tetraplegia: case report. The Journal of Hand Surgery 2012;37(8):1606–1608.CrossRefGoogle Scholar
  36. 36.
    Bertelli JA, Tacca CP, Ghizoni MF, Kechele PR, Santos MA. Transfer of supinator motor branches to the posterior interosseous nerve to reconstruct thumb and finger extension in tetraplegia: case report. The Journal of Hand Surgery 2010;35(10):1647–1651.CrossRefGoogle Scholar
  37. 37.
    Hahn J, Cooper C, Flood S, Weymouth M, van Zyl N. Rehabilitation of Supinator Nerve to Posterior Interosseous Nerve Transfer in Individuals With Tetraplegia. Archives of Physical Medicine and Rehabilitation 2016;97(6 Suppl):S160–S168.Google Scholar
  38. 38.
    Bertelli JA. Transfer of the radial nerve branch to the extensor carpi radialis brevis to the anterior interosseous nerve to reconstruct thumb and finger flexion. The Journal of Hand Surgery 2015;40(2):323–328.e2.CrossRefGoogle Scholar
  39. 39.
    Bertelli JA, Ghizoni MF. Nerve transfers for restoration of finger flexion in patients with tetraplegia. Journal of Neurosurgery Spine 2016:1–7.Google Scholar
  40. 40.
    Hawasli AH, Chang J, Reynolds MR, Ray WZ. Transfer of the brachialis to the anterior interosseous nerve as a treatment strategy for cervical spinal cord injury: technical note. Global Spine Journal 2015;5(2):110–117.CrossRefGoogle Scholar
  41. 41.
    Bertelli JA, Ghizoni MF. Nerve transfers for restoration of finger flexion in patients with tetraplegia. Journal of Neurosurgery Spine 2017;26(1):55–61.CrossRefGoogle Scholar
  42. 42.
    Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. Journal of Neurotrauma 2004;21(10):1371–1383.CrossRefGoogle Scholar
  43. 43.
    Snoek GJ, MJ IJ, Hermens HJ, Maxwell D, Biering-Sorensen F. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord 2004;42(9):526–532.CrossRefGoogle Scholar
  44. 44.
    Davidge KM, Yee A, Moore AM, Mackinnon SE. The Supercharge End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer for Restoring Intrinsic Function: Clinical Experience. Plastic and Reconstructive Surgery 2015;136(3):344e-52e.CrossRefGoogle Scholar
  45. 45.
    Baltzer H, Woo A, Oh C, Moran SL. Comparison of Ulnar Intrinsic Function following Supercharge End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer: A Matched Cohort Study of Proximal Ulnar Nerve Injury Patients. Plastic and Reconstructive Surgery 2016;138(6):1264–1272.CrossRefGoogle Scholar
  46. 46.
    Nadi M, Ramachandran S, Islam A, Forden J, Guo GF, Midha R. Testing the effectiveness and the contribution of experimental supercharge (reversed) end-to-side nerve transfer. Journal of Neurosurgery 2018:1–10.Google Scholar
  47. 47.
    Farber SJ, Glaus SW, Moore AM, Hunter DA, Mackinnon SE, Johnson PJ. Supercharge nerve transfer to enhance motor recovery: a laboratory study. The Journal of Hand Surgery 2013;38(3):466–477.CrossRefGoogle Scholar
  48. 48.
    Kale SS, Glaus SW, Yee A, Nicoson MC, Hunter DA, Mackinnon SE, et al. Reverse end-to-side nerve transfer: from animal model to clinical use. The Journal of Hand Surgery 2011;36(10):1631–1639.e2.CrossRefGoogle Scholar
  49. 49.
    Barbour J, Yee A, Kahn LC, Mackinnon SE. Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation. The Journal of Hand Surgery 2012;37(10):2150–2159.CrossRefGoogle Scholar
  50. 50.
    Makki D, Duodu J, Nixon M. Prevalence and pattern of upper limb involvement in cerebral palsy. Journal of Children's Orthopaedics 2014;8(3):215–219.CrossRefGoogle Scholar
  51. 51.
    Dobkin BH. Clinical practice. Rehabilitation after stroke. The New England Journal of Medicine 2005;352(16):1677–1684.CrossRefGoogle Scholar
  52. 52.
    Chorna O, Heathcock J, Key A, Noritz G, Carey H, Hamm E, et al. Early childhood constraint therapy for sensory/motor impairment in cerebral palsy: a randomised clinical trial protocol. BMJ Open 2015;5(12):e010212.CrossRefGoogle Scholar
  53. 53.
    Leafblad ND, Van Heest AE. Management of the spastic wrist and hand in cerebral palsy. The Journal of Hand Surgery 2015;40(5):1035–1040; quiz 41.CrossRefGoogle Scholar
  54. 54.
    Legg L, Langhorne P. Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials. Lancet 2004;363(9406):352–356.CrossRefGoogle Scholar
  55. 55.
    Zheng MX, Hua XY, Feng JT, Li T, Lu YC, Shen YD, et al. Trial of Contralateral Seventh Cervical Nerve Transfer for Spastic Arm Paralysis. The New England Journal of Medicine 2018;378(1):22–34.CrossRefGoogle Scholar
  56. 56.
    Ives GC, Kung TA, Nghiem BT, Ursu DC, Brown DL, Cederna PS, et al. Current state of the surgical treatment of terminal neuromas. Neurosurgery. 2018;83(3):354–364.Google Scholar
  57. 57.
    Barbour JR, Yee A, Moore AM, Trulock EP, Buchowski JM, Mackinnon SE. Cadaveric nerve allotransplantation in the treatment of persistent thoracic neuralgia. The Annals of Thoracic Surgery 2015;99(4):1414–1417.CrossRefGoogle Scholar
  58. 58.
    Mackinnon SE. Wandering nerve graft technique for management of the recalcitrant painful neuroma in the hand: a case report. Microsurgery 1988;9(2):95–102.CrossRefGoogle Scholar
  59. 59.
    Souza JM, Cheesborough JE, Ko JH, Cho MS, Kuiken TA, Dumanian GA. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clinical Orthopaedics and Related Research 2014;472(10):2984–2990.CrossRefGoogle Scholar
  60. 60.
    Woo SL, Kung TA, Brown DL, Leonard JA, Kelly BM, Cederna PS. Regenerative Peripheral Nerve Interfaces for the Treatment of Postamputation Neuroma Pain: A Pilot Study. Plastic and Reconstructive Surgery Global Open 2016;4(12):e1038.CrossRefGoogle Scholar
  61. 61.
    Kuiken TA, Miller LA, Lipschutz RD, Lock BA, Stubblefield K, Marasco PD, et al. Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study. Lancet 2007;369(9559):371–380.CrossRefGoogle Scholar
  62. 62.
    Cheesborough JE, Smith LH, Kuiken TA, Dumanian GA. Targeted muscle reinnervation and advanced prosthetic arms. Seminars in Plastic Surgery 2015;29(1):62–72.CrossRefGoogle Scholar
  63. 63.
    Bowen JB, Wee CE, Kalik J, Valerio IL. Targeted Muscle Reinnervation to Improve Pain, Prosthetic Tolerance, and Bioprosthetic Outcomes in the Amputee. Advances in Wound Care 2017;6(8):261–267.CrossRefGoogle Scholar
  64. 64.
    Morgan EN, Kyle Potter B, Souza JM, Tintle SM, Nanos GP, 3rd. Targeted Muscle Reinnervation for Transradial Amputation: Description of Operative Technique. Techniques in Hand & Upper Extremity Surgery 2016;20(4):166–171.Google Scholar
  65. 65.
    Gart MS, Souza JM, Dumanian GA. Targeted Muscle Reinnervation in the Upper Extremity Amputee: A Technical Roadmap. The Journal of Hand Surgery 2015;40(9):1877–1888.CrossRefGoogle Scholar
  66. 66.
    Kuiken TA, Barlow AK, Hargrove L, Dumanian GA. Targeted Muscle Reinnervation for the Upper and Lower Extremity. Techniques in Orthopaedics (Rockville, Md). 2017;32(2):109–116.CrossRefGoogle Scholar
  67. 67.
    Pet MA, Ko JH, Friedly JL, Mourad PD, Smith DG. Does targeted nerve implantation reduce neuroma pain in amputees? Clinical Orthopaedics and Related Research 2014;472(10):2991–3001.CrossRefGoogle Scholar
  68. 68.
    Ducic I, Mesbahi AN, Attinger CE, Graw K. The role of peripheral nerve surgery in the treatment of chronic pain associated with amputation stumps. Plastic and Reconstructive Surgery 2008;121(3):908–914; discussion 15-7.CrossRefGoogle Scholar
  69. 69.
    Poppler LH, Parikh RP, Bichanich MJ, Rebehn K, Bettlach CR, Mackinnon SE, et al. Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis. Pain 2018;159(2):214–223.CrossRefGoogle Scholar

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryStanford UniversityStanfordUSA

Personalised recommendations