Upper-Extremity Nerve Transfers for Sensation: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Regenerative Medicine

Background:

• Peripheral nerve injuries in the upper extremity often impair protective sensation and tactile perception.
• Restoring sensation is crucial for function and quality of life.
• Limited literature exists on optimal donor-recipient configurations for sensory nerve transfers.

Purpose of the Study:

• To systematically review reported sensory nerve transfers in the upper extremity.
• To identify effective donor-nerve and recipient-nerve combinations for sensation restoration.

Main Methods:

• Systematic review of original articles from 1982-2022 in MEDLINE and EMBASE.
• Inclusion of studies reporting patient sensory outcomes (modified British Medical Research Council scale S3 or better defined as satisfactory).
• Analysis of 39 eligible articles, including 27 primary research studies on 197 patients.

Main Results:

• The proper ulnar digital nerve of the small finger was the most reliable recipient for ulnar border sensation (89% satisfactory).
• For the small finger's ulnar border, the long finger's proper ulnar digital nerve (87.5% good outcome) and the median nerve's palmar cutaneous branch (100% good outcome) were effective donors.
• The superficial branch of the radial nerve was the best donor for the thumb's ulnar border and index finger's radial aspect.

Conclusions:

• Sensory nerve transfers generally achieve good outcomes.
• Transferring into a digital nerve recipient is recommended for sensation reconstruction.
• Specific donor-recipient pairs show high success rates for targeted sensory restoration.