Heterotopic nerve transfers: recent trends with expanding indication

There has been increasing enthusiasm for heterotopic nerve transfers for brachial plexus palsy as well as peripheral mononeural dysfunction. The concept of nerve transfer surgery is not new; the first publications on the topic date back to the early 1900s. A wide variety of potential donor nerves are available including the intercostal nerves, the spinal accessory nerve, the phrenic nerve, the ipsilateral medial pectoral nerve, partial ulnar nerve, partial median nerve, thoracodorsal nerve, radial nerve to the triceps, and the ipsilateral C7 or the contralateral C7 nerve roots. Treatment strategies include avoidance of interposed nerve grafting, isolated motor recipient nerve, early transfer, neurorrhaphy close to target motor end plates, and similar diameter between donor nerve and recipient nerves.