Modified Oberlin double fascicular nerve transfer for elbow flexion: FCR fascicle to motor branch to biceps and FCU fascicle to motor branch to brachialis
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Christophe Oberlin popularised the technique of nerve transfer for restoration of elbow flexion after upper brachial plexus palsy. The original technique involved highly selective fascicle transfer of a predominant flexor carpi ulnaris fascicle from the ulnar nerve to the motor branch to biceps. The technique enabled reliable and rapid re-innervation of biceps and superior results to nerve grafting for upper trunk ruptures. Modifications have included a double transfer technique using fascicles from both median and ulnar nerves transferred to the motor branches to biceps and to brachialis. I use a double technique in cases of complete elbow flexion paralysis with loss of biceps, brachialis and brachioradialis such as that resulting from a C5/6 avulsion injury or delayed presentation following rupture of the upper trunk. In cases of isolated musculocutaneous injury, proximal reconstruction for biceps can be combined with a single distal transfer to the brachialis from the ulnar nerve. The technique can also be used to salvage late presenting upper trunk or lateral cord ruptures where the time-distance phenomenon dictates that late nerve graft of a proximal rupture is unlikely to be successful or cases where proximal reconstruction has failed to provide functional elbow flexion by 9 months following injury.
Author:Dominic Power FRCS Orth, Consultant Hand and Peripheral Nerve Surgeon
Institution: Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, UK