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Updated: May 2, 2026
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Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
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Nerve transfers for the upper extremity function restoration
Lukas Rasulić1,2, Andrija Savić1,2, Milan Lepić3,4
1Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Brain & Spine
|May 1, 2026
Summary
Nerve transfers are now a primary strategy for severe nerve injuries like brachial plexus injury. Distal coaptation techniques improve functional recovery and patient quality of life by optimizing nerve regeneration.
Area of Science:
- Neurosurgery
- Peripheral Nerve Regeneration
- Reconstructive Surgery
Background:
- Nerve transfers have evolved from salvage procedures to a primary, biology-based approach.
- Severe peripheral nerve injuries, especially brachial plexus injuries, necessitate advanced reconstructive strategies.
Purpose of the Study:
- To summarize the historical context and modern rationale for nerve transfer surgery.
- To outline the principles and advantages of distal coaptation in nerve transfers.
- To discuss the integration of distal transfers within contemporary reconstructive algorithms.
Main Methods:
- Review of historical nerve transfer techniques.
- Outline of modern rationale for distal coaptation, focusing on biological principles.
- Discussion of donor-recipient selection criteria (redundancy, axonal capacity, proximity, synergy).
- Contrast of proximal versus distal transfer concepts.
- Presentation of representative examples integrating distal transfers with other reconstructive modalities.
Main Results:
- Distal coaptation shortens regeneration distance, bypasses scar tissue, and directs axons to functional targets.
- Nerve transfers, particularly distal ones, can be effectively combined with grafting, tendon transfers, or free muscle transfer.
- Clinical experience shows high rates of functionally meaningful recovery and improved patient-reported quality of life.
Conclusions:
- Distal nerve transfers represent a significant advancement in treating peripheral nerve injuries.
- This approach optimizes nerve regeneration and functional restoration, enhancing patient outcomes.
- Nerve transfers are a cornerstone of modern reconstructive surgery for peripheral nerve deficits.
