Never transfer for wrist function reconstruction in BPAI patients

The treatment of BPI especially avulsion injury cases is always a challenge for hand surgeons. The function reconstruction of wrist is difficult and the result is not always satisfied. Nerve transfer is the first option and it is recognized as the most successful method.  

For the patients with C5-C8 injury, the function of wrist flexion is remained but the function of wrist extension is always lost. The treatment scheme is SAN transfer to SSN for shoulder function, ICNS transfer to Axillary nerve for shoulder function, ICNS transfer to biceps branch for elbow flexion and ICNS transfer to radial nerve for wrist and finger extension. 

For the patients with C5-T1 injury, both of the wrist flexion and wrist extension are lost. The treatment scheme is SAN transfer to SSN for shoulder function, ICNS transfer to Axillary nerve for shoulder function, ICNS transfer to triceps branch for elbow extension and ICNS transfer to radial nerve for wrist and finger extension, contralateral C7 nerve transfer to biceps branch together with median nerve for elbow flexion as well as wrist and finger flexion. 

The effective recovery rate of wrist extension reconstructed by ICNs transfer is 51.61%. The effective recovery rate of wrist flexion reconstructed by cC7 nerve transfer is 72.73%. 

At least 2 ICNs need to be used as the donor for radial nerve function reconstruction. The entire cC7 nerve must be harvested to be the donor for the reconstruction of median nerve function.