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Justin M. Brown, Manish N. Shah and Susan E. Mackinnon

D istal nerve transfers require the cutting of healthy nerves subserving one function and suturing of these proximal donors to selected branches within a region of denervation to restore a specific motor or sensory function. 20 Lurje 19 was an early pioneer in the use of nerve transfers to treat Erb palsy, and since that time such techniques have been widely used as the intervention of choice in cases of nerve root avulsion. Over the last decade, a plethora of new nerve transfer procedures has been added to the repertoire of the peripheral nerve surgeon

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Arvin R. Wali, Charlie C. Park, Justin M. Brown and Ross Mandeville

23 : 261 – 266 , 2009 10.1097/BOT.0b013e31819dfa04 19318869 18 Nagano A : Treatment of brachial plexus injury . J Orthop Sci 3 : 71 – 80 , 1998 10.1007/s007760050024 9654558 19 Nath RK , Lyons AB , Bietz G : Physiological and clinical advantages of median nerve fascicle transfer to the musculocutaneous nerve following brachial plexus root avulsion injury . J Neurosurg 105 : 830 – 834 , 2006 17405252 10.3171/jns.2006.105.6.830 20 Novak CB , Anastakis DJ , Beaton DE , Katz J : Patient-reported outcome after peripheral nerve

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Anil Bhatia, Piyush Doshi, Ashok Koul, Vitrag Shah, Justin M. Brown and Mahmoud Salama

with permission from Wang SF, Li PC, Xue YH, Yiu HW, Li YC, Wang HH: Contralateral C-7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion. J Bone Joint Surg Am 95: 821–827, 2013, . Fig. 2. A: Intraoperative photograph showing resection of 2.5 to 3.5 cm of the proximal humerus and approximation of the bone ends ( arrow ). B: After humeral shortening, a dynamic compression plate is used to fixate the humerus at the new shortened length to shorten the

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Justin M. Brown, Mark A. Mahan, Ross Mandeville and Bob S. Carter

transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion . J Bone Joint Surg Am 95 : 821–827 , S1 – S2 , 2013 49 Wenger N , Moraud EM , Gandar J , Musienko P , Capogrosso M , Baud L , : Spatiotemporal neuromodulation therapies engaging muscle synergies improve motor control after spinal cord injury . Nat Med 22 : 138 – 145 , 2016 10.1038/nm.4025 26779815 50 Wyndaele M , Wyndaele JJ : Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey

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Arvin R. Wali, David R. Santiago-Dieppa, Justin M. Brown and Ross Mandeville

T rauma to nerve roots C5–T1 caused by contusions, lacerations, gunshot wounds, penetrative injury, or traction injuries can cause pan–brachial plexus injury (PBPI). 17 , 21 A significant subset of these patients have preganglionic avulsions that would preclude spontaneous recovery. 10 , 21 Adult patients with brachial plexus injury are disproportionately young males, with mean ages ranging from 25 to 29 years old, who can experience major disability and a lower quality of life after injury. 20 While published surveys indicate that restoration of elbow