Abstract
Background Nerve transfer can be broadly separated into two categories: proximal nerve graft
and/or transfer and distal nerve transfer. The superiority of proximal nerve graft/transfer
over distal nerve transfer strategy has been debated extensively, but which strategy
is the best has not yet been defined. Each technique has its own advantages and disadvantages.
However, proximal nerve graft/transfer is still the main reconstructive procedure
based on the principle of “no diagnosis, then no treatment.” Proximal nerve transfer
can avoid iatrogenic injury where the lesion is still in continuity and neurolysis
is the only procedure without further cutting the nerve.
Results Our clinical and experimental study show that proximal nerve grafts/transfers yield
at least equal or better results compared to distal nerve transfers. Proximal nerve
grafts/transfers remain the mainstay of my reconstructive strategy. Proximal nerve
graft/transfer offers more accurate diagnosis and proper treatment to restore shoulder
and elbow functions simultaneously. Distal nerve transfers can offer more efficient
elbow flexion.
Conclusion Combined, both strategies in primary nerve reconstruction are especially recommended
when there is no healthy or not enough donor nerve available Distal nerve transfers
should be considered as a complementary option for proximal nerve grafts/ transfers.
Keywords
brachial plexus injury - distal nerve transfer - proximal nerve transfer - level of
brachial plexus injury
