Brachialis to Anterior Interosseous Nerve Transfer with Extension - Standard

Brachialis to Anterior Interosseous Nerve Transfer with Extended Forearm Incision - Standard
Authors: Mackinnon SE1, Yee A1
Published: November 18, 2014

AUTHOR INFORMATION
1 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Loss of flexor pollicis longus and radial profundus function results in a deficit of pinch and reduced grip strength in the hand. This palsy can be isolated or commonly included in a lower brachial plexus injury. The brachialis nerve is an available, synergistic, and powerful donor for transfer in these scenarios, especially in C7,8,T1 injuries and when other common donors are unavailable due to injury like the extensor carpi radialis brevis. In this case, the patient presented three months following a partial C7 and C8,T1 brachial plexus injury from a fall with no recovery on electrodiagnostic studies. The brachialis to anterior interosseous nerve transfer was elected with the supinator to flexor digitorum superficialis nerve transfer and lateral antebrachial cutaneous to ulnar sensory nerve transfer. This video details the specifics for the brachialis transfer with an extended incision into the forearm to confirm the proximal topography of the anterior interosseous fascicle in the median nerve. Additionally, this patient has an anomalous sensory nerve anastomosis from a brachialis nerve branch to the sensory component of the median nerve.