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Wilson Z. Ray, Chester K. Yarbrough, Andrew Yee and Susan E. Mackinnon

B rachial plexus injuries represent a significant public health problem. Most commonly affecting young males, these injuries often leave individuals with permanent disability. Over the past decade, there have been significant advances in the options for surgical treatment of these lesions, and nerve transfers have greatly improved surgical results for management of upper plexus injuries. The surgical options for lower plexus injuries, however, remain more limited. Thus, while the advent of nerve transfers has provided a significant advance in the treatment

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Andrés A. Maldonado and Robert J. Spinner

S pinal accessory nerve (SAN) injury results in loss of motor function of the trapezius muscle and leads to weakness of the shoulder in abduction, winging of the scapula, drooping of the shoulder, and pain and stiffness in the shoulder girdle. The majority of the cases of SAN injury occur in the posterior triangle of the neck. When the SAN is transected or a nonrecovering neuro main-continuity is observed, the standard treatment would include a primary end-to-end or graft repair. 2 Nerve transfers may be considered, especially in cases of proximal injury

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Wilson Z. Ray, Mitchell A. Pet, Michael C. Nicoson, Andrew Yee, Lorna C. Kahn and Susan E. Mackinnon

options, there is no established consensus on the preferred treatment of this condition. Physical therapy and watchful waiting are commonly recommended, and there are several documented cases describing favorable outcomes with this conservative strategy. 23 Unfortunately, predicting which patients will make a full recovery with conservative management is difficult, and recent data suggests that this approach to idiopathic brachial plexopathies leaves many patients with significant residual pain and disability. 21 Nerve transfer is not generally considered in the

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Susan E. Mackinnon, Brandon Roque and Thomas H. Tung

transfers has been the mainstay of treatment. 5 , 6 , 22 , 51 The technique of nerve transfer has been used with increasing frequency for motor and sensory reconstruction of proximal upper-extremity nerve and brachial plexus injuries. 27 , 38 , 60 Nerve transfers at the level of the upper arm and shoulder have conventionally been used to restore shoulder and elbow function after brachial plexus root avulsion injury. 26 , 54 , 56 In the forearm, nerve transfers from redundant or expendable motor branches of the median nerve have been reported with good outcomes. 24

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Konstantinos Spiliopoulos and Ziv Williams

to travel to reach the muscle end-organ is longer. 12 , 15 , 26 , 27 , 35 Therefore, neurotization, or nerve transfer, offers an important alternative to direct nerve repair, whereby a healthy donor nerve that does not naturally supply the muscle of interest is coapted to a nonfunctional nerve. 23 , 34 , 37 , 38 The benefit of this approach is that the functional donor nerve can be sutured in immediate proximity to the muscle end-organ of interest and thus provide earlier innervation. Moreover, recovery does not rely on the extent or location of injury of the

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Johannes A. Mayer, Laura A. Hruby, Stefan Salminger, Gerd Bodner and Oskar C. Aszmann

long regeneration distances as well as the use of sensory nerve grafts often result in poor outcome of trapezius function. 1 , 2 , 17 In very proximal lesions, identification of the proximal nerve stump may be further complicated. There are few reports with a limited number of patients on nonsynergistic motor nerve transfers, e.g., the lateral pectoral nerve, to restore trapezius function, yielding promising results. 5 , 13 , 14 , 16 , 20 Here, we report distal nerve transfer using motor fibers of the upper trunk related to axillary nerve function for reinnervation

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Martijn J. A. Malessy, Carel F. E. Hoffmann and Ralph T. W. M. Thomeer

T raction injuries of the brachial plexus may result in nerve rupture and root avulsion. In reconstructing the plexus, proximal spinal nerve stumps are used as lead outs for the grafts. Extra—intraplexal nerve transfers can be applied when spinal roots are avulsed from the cord and the number of proximal stumps available is limited. 24 Because the results of grafting are superior to those of transfer, grafts are applied preferentially in pursuing the main goals of reconstruction. 2, 16 Restoration of function has been reported in humans after reimplantation of

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

management and operative management. Compared with conservative measures, surgical intervention via nerve transfers has been shown to significantly improve neurological function. 15 , 18 , 27 Prompt surgical intervention within 6 months of injury has been associated with a more favorable outcome compared with delayed surgical treatment. 4 For patients who undergo conservative treatment, 12%–41% may experience spontaneous recovery within the first 3 months. 15 , 18 However, after this interval, spontaneous recovery and restoration of full neurological function becomes

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Susan E. Mackinnon, Andrew Yee and Wilson Z. Ray

a reliable and robust improvement in functional outcomes. We have developed a number of nerve transfers for forearm and hand motor function, 7 , 20 , 49 , 59 and recently Bertelli and colleagues have described the successful reinnervation of distal musculature with preserved proximal donors after an SCI. 4 , 5 , 20 We present in the current article a single case of restoration of some finger and thumb flexion that allowed this patient to feed himself after a cervical SCI. Case Report History This 71-year-old previously right-hand-dominant man

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Jayme A. Bertelli and Marcos F. Ghizoni

' acceptance for tendon transfer surgery. More recently the use of distal nerve transfers has emerged as an adjunct therapy to improve upper limb function in patients with tetraplegia. 6 , 12 In this strategy, by crossing peripheral nerves, axons from motoneurons that originate above the lesion level and have functional cortical drive are rerouted to reinnervate target muscles that are normally innervated by motoneurons located below the spinal cord lesion. In patients with midcervical spinal cord injuries, distal nerve transfer resulted in predictable restoration of