Transfer of a Radial Nerve Branch to the Brachialis Nerve for Restoration of Elbow Flexion

Nerve transfers for brachial plexus reconstruction and the treatment of peripheral nerve injury have demonstrated excellent clinical outcomes and may be superior to nerve grafting. Previously described nerve transfers for restoration of elbow flexion include the Oberlin (ulnar to musculocutaneous) and double fasicular (median to biceps and ulnar to brachialis) transfers. However, these transfers cannot be performed in patients with loss of elbow flexion and concomitant high median and ulnar nerve injury. Other transfers utilizing the thoracodorsal or intercostal nerves have been described; however, this requires sacrifice of the latissimus dorsi muscle or potential nerve donors for a free, functioning gracilis muscle transfer. The triceps lower medial head and anconeus motor branch is a frequently used nerve donor with minimal morbidity. As an alternative for this specific patient population, we report the transfer of the triceps lower medial head and anconeus motor branch to the brachialis nerve as an option to restore elbow flexion.