Median and/or Ulnar Nerve Fascicle Transfer for the Restoration of Elbow Flexion in Upper Neonatal Brachial Plexus Palsy.

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Transfer of a fascicle of the ulnar and/or median nerve to the musculocutaneous nerve in order to reinnervate the biceps and/or brachialis muscles has a high success rate and a low rate of complications in infants with upper (C5-C6) or extended upper (C5-C7) neonatal brachial plexus palsy. Make a longitudinal incision along the midline of the middle third of the medial brachium. The musculocutaneous nerve is typically found on the undersurface of the biceps muscle. The median nerve runs along the neurovascular sheath medial to the brachial artery. The ulnar nerve lies posterior to the intermuscular septum. Cut the donor fascicles distally and the recipient fascicles proximally to facilitate transfer. Irrigate the wound, and close it in layers. Remove the bandages two weeks postoperatively, and encourage passive range-of-motion exercises. In our series, thirty-one patients underwent single or combined nerve fascicle transfer; twenty-seven (87%) obtained functional elbow flexion recovery (Active Movement Scale [AMS] score ≥ 6) while twenty-four (77%) obtained full elbow flexion recovery (AMS score = 7). Indications Contraindications Pitfalls & Challenges.