Peripheral Nerve Transfers: Core Principles and Workhorse Techniques

Despite the long history of experience in peripheral nerve reconstruction, dating back to the 1870s, recent decades have seen an explosion of innovation. Advancements have been made in primary repair, secondary repair, nerve grafts, tendon transfers, and, most recently, nerve transfers. These innovations address the distance-to-target problem faced by surgeons and provide improved functional outcomes. Key principles for successful nerve transfers include proper patient selection, preoperative discussions, intraoperative decisions, and postoperative management. In this review, we discuss 3 common peripheral nerve transfers: the anterior interosseous nerve to ulnar nerve transfer, median to radial nerve transfers, and the tibial to peroneal nerve transfer. These techniques can restore functional mobility in patients with severe peripheral nerve injuries.