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Costa et al. Plast Aesthet Res 2020;7:32  I  http://dx.doi.org/10.20517/2347-9264.2020.43                                           Page 9 of 12

               Table 1. Motory nerve transfers in distal forearm and in the hand
                       Recipient  Donor  Modality       Advantage                 Disvantage         Ref.
                Median   TBMN  AIN    End-to-End  Congruous number of Axon  Not available in high median nerve   [10-12]
                N. Lesion     (Pronator)                                  lesion
                                                                          Interpositional nerve graft needed
                       TBMN   EDMNB   End-to-End                          Unclear results          [4]
                       TBMN   ECUMB   End-to-End                          Unclear results          [4]
                       TBMN   TLMB    End-to-End                          Unclear results          [13]
                       TBMN   ADQMB   End-to-End  No need of interpositional nerve graft           [14]

                Ulnar N.   MBUN  AIN  End-to-End  No need of interpositional nerve graft Dispersion of axons to the hypotenar  [4,22,25]
                Lesion        (Pronator)        Reliable technique        musculature
                       MBUN   AIN     SETS      Allow the ulnar nerve to regenerate   Unclear results  [30,31]
                              (Pronator)        spontaneously
                       MBUN   MBMN    DBNG      Allow the ulnar nerve to regenerate   Interpositional nerve graft needed  [32]
                                                spontaneously             Unclear results
                       MBUN   EDMNB   End-to-End  Low morbidity           Interpositional nerve graft needed  [34]
                                                                          Suboptimal results
                       MBUN    ECUMB  End-to-End  Low morbidity           Interpositional nerve graft needed  [34]
                                                                          Suboptimal results
                       DMBUN   TBMN   DBNG      Allow the ulnar nerve to regenerate   Interpositional nerve graft needed  [35]
                                                spontaneously
                       TDDBUN OPB     End-to-End  Very distal transfer                             [37]
                                                Can restore pinch strength
                                                Could be combined with the AIN
                                                nerve transfer
               TBMN: Thenar branch of median nerve; AIN: anterior interosseous nerve; EDMNB: extensor digiti minimi motor branch; ECUMB:
               extensor carpi ulnaris motor branch; TLMB: third lumbrical motor branch; ADQMB: abductor digiti quinti motor branch; MBUN: motor
               branch of ulnar nerve; SETS: supercharged end to side; MBMN: motor branch of median nerve; DBNG: double bridging nerve graft;
               DMBUN: deep motor branch of ulnar nerve; TDDBUN: terminal division deep branch of the ulnar nerve; OPB: opponens pollicis branch

               Other strategies involve direct end-to-end coaptation including between the palmar cutaneous branch of
               the median nerve as donors and the ulnar dorsal nerve [22,56,58] .


               Nerve transfers to restore ulnar sensation: technique
               Nerve transfers to restore sensation of the ulnar nerve are generally performed simultaneously with motor
               transfers. Sensory fascicles of the ulnar nerve are dissected proximally. Distal to the carpal tunnel, it is
               possible to recognize the fascicles directed to the third interdigital space. These are dissected proximally
               to the distal forearm. Here the sensory fascicles of the ulnar nerve and the fascicles directed to the third
               web space are coapted end-to-end as illustrated in Figure 7. The dorsal cutaneous ulnar branch is divided
               proximally and transferred, tension free, to the median nerve. Protective sensation of the third web space
               is maintained through end-to-side coaptation between the distal stump of the fascicle and the sensitive
               portion of the median nerve itself.


               CONCLUSION
               Nerve transfers in the distal forearm and hand appear to be a viable and promising option in patients with
               peripheral nerve injuries. The numerous advantages offered by transposition of a functional nerve stump
               near the effector muscle have opened up new alternatives to nerve grafts and tendon transfers, for the
               treatment of nerve injuries. The surgeon who performs brachial plexus surgery must be able to provide the
               best treatment for the patient and his needs. The complexity of the anatomical components and the density
               of the nerve structures in the distal forearm and hand give rise to various reconstructive possibilities. The
               main nerve transfers of the distal forearm and in the hand have been summarized in Tables 1 and 2. The
               addition of new concepts such as very distal nerve transfers and end-to-side coaptations have led to new
               solutions for previous problems in which solutions were more complex and are sometimes associated with
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